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If you’re having or have had a mastectomy to treat breast cancer, your doctor has likely talked with you about breast reconstruction surgery. As of 2016, more than 40 percent of women in the U.S. who’d had a mastectomy also had breast reconstruction surgery. More than 4,400 MyBCTeam members report that they’ve had reconstruction.
The choice to have reconstruction surgery is completely up to you. Many people weigh the pros and cons of additional surgery, taking into account their health status, appearance, and whether they’ll be undergoing additional breast cancer treatment. Communicating openly with your doctor and care team about your thoughts is an important part of the decision process, so it’s best to understand your options beforehand.
Deciding whether to undergo breast reconstruction can be difficult, and there are several factors to think about. Your doctor may offer to do reconstruction during a lumpectomy — the removal of a portion of a breast — or mastectomy — removal of an entire breast. Alternatively, you can choose to have the reconstruction done later after you’ve healed from surgery. If you are having or have had a single or double mastectomy, you may want to consider whether you’ll have one or both breasts reconstructed. Some people choose to have both done after a single mastectomy so their breasts will have a similar appearance.
Some MyBCTeam members have discussed their experiences with breast reconstruction, including how it has affected their self-esteem. One member said, “I can’t explain it, but I do feel a different confidence now that I’ve had reconstruction.”
Another member commented, “I, too, was very happy that I did reconstruction. It looks different, I still have to wear small inserts in my bra, but it was a great self-esteem booster for me.”
If you choose not to have reconstruction, you may opt to wear a breast prosthesis that looks similar to a natural breast. This is a foam or silicone breast-shaped prosthesis that can be placed in your bra or bathing suit to fill out the shape.
When choosing the timing of reconstruction surgery, there are a few factors to consider, including follow-up treatments after surgery, the type of breast cancer you have, and your personal preferences.
Immediate reconstruction is performed during a mastectomy. Most people choose to have immediate reconstruction, which accounts for around 75 percent of reconstruction cases in the U.S., according to the U.S. Agency for Healthcare Research and Quality.
Potential benefits of Immediate reconstruction include:
However, not everyone is a candidate for immediate reconstruction.
Delayed reconstruction can occur weeks, months, or even years after an initial breast cancer surgery. This gives your body time to heal and you time to finish any adjuvant treatments (additional treatments aimed at keeping cancer from returning). If you receive radiation therapy or chemotherapy after surgery, your doctor will likely delay reconstruction. This is because these treatments can interfere with the healing process and can lead to changes in the breast's appearance and color.
Ultimately, the decision on the timing of reconstruction is up to you and your oncologist. Some people choose to delay so they can heal from surgery. One MyBCTeam member shared, “The surgeon asked me about reconstruction. I told them no for now. My main concern is getting rid of the cancer first. Then maybe later on down the road.”
Once you’ve chosen to have reconstruction, your doctor will discuss your options as to what type you’ll receive. There are several factors that play into which type of reconstruction you will have, including:
Together, you and your doctor will determine the best option. There are two main types of breast reconstruction surgeries — implant reconstruction or tissue or flap reconstruction.
Within these, there are many more options to choose from, depending on your goals and other factors. Nipple reconstruction can also be performed after the breasts heal. Some people may also choose to have surgery to change the unaltered breast, such as a breast reduction or lift, to achieve better symmetry between the breasts.
Breast implant reconstruction is the most common procedure in the U.S., accounting for around 80 percent of reconstruction surgeries in 2019. This method uses a flexible silicone implant filled with silicone gel or saline to replace the removed breast tissue. Breast implants are a good option for those who:
During your mastectomy, your surgeon may place a tissue expander. This is an empty breast implant that is filled with air or water over the course of six to eight weeks, which helps the breast tissue around it expand. This prepares the body for a more permanent implant later on.
When choosing a plastic surgeon to perform this procedure, ask them questions about their experience and the techniques they use. Communication is important, especially in regard to your reconstruction goals.
While similar in appearance to natural breasts, breast implants tend to feel much different. They come in many different shapes and sizes to help you achieve a certain look. All implants are made of silicone and are filled with either silicone gel or saline.
Silicone gel implants are prefilled with a gel and then inserted into the breast tissue. These implants tend to mimic the natural breast tissue better than saline implants because they look and feel softer.
There is a small chance a silicon implant may eventually start to leak (called a gel fracture), spilling silicone gel into the body. This rupture can be difficult to detect because the implant often holds its shape. Sometimes, symptoms of a rupture may develop, including pain, irritation, or lumps, according to Mayo Clinic. A rupture also may affect the appearance or feel of the breast. In other cases, the symptoms of a rupture can be quite minimal, which is called a silent rupture. Researchers have not found these ruptures to cause serious health complications like reproductive issues or connective tissue disease, per Mayo Clinic.
The U.S. Food and Drug Administration (FDA) recommends that people who receive implants undergo periodic MRIs or ultrasounds to ensure there are no ruptures. These begin around five to six years after the implant is placed and they should be repeated every two to three years.
If an implant does rupture, you should speak with your health care provider as to whether to wait and see how it progresses or to have it replaced.
Saline implants, on the other hand, arrive empty and are filled with salt water after the plastic surgeon places them in the body. They often feel firmer than silicone gel implants. Because they are filled with salt water, you are not required to have screenings done after receiving one of these implants.
If they burst, your breast will “deflate,” which you’ll likely notice. The salt water that leaks into the body will be absorbed without causing health or safety issues. If this happens, you will need to have surgery to remove or replace the shell.
The other option for reconstruction is tissue reconstruction, also known as autologous or flap reconstruction. This method uses a person’s own tissue to rebuild the breast shape. Typically, a flap of skin and fat is removed from another area on the body — such as the back, inner thighs, buttocks, or belly.
Depending on your surgeon’s skills and experience, you may either have a free flap or a pedicled flap. A free flap is a tissue that is completely separated from its blood vessels and moved to the breast. On the other hand, a pedicled flap still has the original blood vessels attached and it is moved to your chest and placed under the skin. There, it is formed into a breast shape. Pedicled flaps are more common, as most surgeons are more experienced with them, and the procedure doesn’t require having to separately reconnect the blood supply to the tissue.
Many MyBCTeam members who’ve had tissue reconstruction have either had the TRAM flap (which stands for transverse rectus abdominis), in which skin is taken from the abdomen, or the latissimus dorsi flap, which is taken from the back.
There are some advantages to tissue reconstruction over implants. The tissues used in this surgery tend to feel more like natural breasts compared to implants. Additionally, once the procedure is complete, the reconstructed breast will typically last for a lifetime. Implants, on the other hand, need to be replaced every few decades. However, tissue reconstruction does require more surgery in order to remove the tissue flap.
After a mastectomy, some people also choose to undergo a nipple reconstruction. This is typically done a few months after breast reconstruction surgery so that the tissues have healed and settled into their final positions. The dark area around the nipple, known as the areola, can also be tattooed on to give the breast a more natural look.
Nipple reconstruction surgery uses tissue from the reconstructed breast to create a nipple that projects out from the breast. However, this tends to flatten over time and requires more surgery, extending recovery times. Some people choose to have the surgery and others do not.
In the U.S., insurance companies that cover mastectomies are also required to cover breast reconstruction surgery. The exact costs covered by insurance will depend on your specific plan. If you need extra assistance paying for reconstruction surgery, there are breast cancer support and awareness groups that offer grants to help cover costs. A quick internet search is a good place to start looking for help.
On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.
Have you had breast reconstruction surgery? What type did you have and what was your experience? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Jonas DeMuro, M.D. is a critical care surgeon on Long Island, NY. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.
