Deciding whether or not to have a breast rebuilt is a very personal choice. Take the time you need to learn about how breast reconstruction might affect you, both emotionally and physically, before you decide to have the surgery.
Also think about whether you’re open to having no reconstruction. This could be your most flexible option – you can go breast-free, use a pop-in breast form, or change your mind and get breast reconstruction in the future.
Talk to all of your cancer doctors and your plastic surgeon about the best options for your unique situation. A plastic surgeon who's experienced in all the options you're considering may offer you the most complete review of all your choices.
Talking to other women who have had -- or who haven't had -- breast reconstruction can give you more personal opinions about your options. There’s nothing like hearing from other women who’ve been through it before – and they may even be willing to share photos. Some great places to go are the Breastcancer.org Discussion Board forums called Breast Reconstruction and Living Without Reconstruction After a Mastectomy, where women share experiences and support each other. The site BreastFree is devoted to sharing stories, photos, and other information about opting to have no reconstruction after mastectomy. Many women call this "going flat."
Here are some things you might want to consider while you're making a decision about breast reconstruction:
- Is it important to you to have a permanent breast shape? Some women prefer to wear a prosthesis instead of having reconstruction. Other women opt for no reconstruction and no prosthesis. And still other women feel that a reconstructed breast is more convenient than wearing, removing, and taking care of a prosthetic breast.
- If you’re having a mastectomy on one breast, is it important to you that your breasts look balanced when wearing a bra or bathing suit? After mastectomy, many women want their breasts to have a natural, balanced appearance in bras, bathing suits, and other garments with low necklines. Though you’ll be able to see the difference between the rebuilt breast and your other breast when you're naked, reconstruction usually looks very natural when you're wearing a bra or bathing suit. Similarly, a prosthesis can give you a balanced appearance in clothes, including a bathing suit. Having one breast removed and opting for no reconstruction may give you a somewhat unsymmetrical appearance if you don’t wear a prosthesis, depending on the size of your remaining breast. Still, many women who decide to have no reconstruction and no prosthesis say it’s not a big deal.
- In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes. Talk to your plastic surgeon about what needs to be done, both immediately and later, as you consider your options. For example, if you have very large breasts, the reconstruction might create a smaller breast. In this case, you might have the affected breast reconstructed, followed by reduction surgery on the other breast. Some time later, you'd have the opportunity to get nipple reconstruction on the rebuilt breast.
- How important is it that you be able to resume your normal activities as soon as possible? In most cases, women who choose no reconstruction are able to resume their daily activities more quickly than women who choose reconstruction.
- Are you an athlete? Autologous reconstruction uses skin, fat, and sometimes muscle from other areas of the body (abdomen, back, buttocks, thighs) to rebuild the breast. In some cases, you may have muscle weakness or loss of function at the donor site because muscle has been moved or cut through. Implant reconstruction, a prosthesis, and opting for no reconstruction are choices don’t have this risk.
- Is the cost of reconstruction surgery a concern for you? Opting for no reconstruction and no prosthesis is the least expensive option. If you want to have a breast shape without additional surgery, a prosthesis may be an affordable choice. Reconstruction with an implant is the least expensive reconstruction option; GAP flap reconstruction using tissue from the buttocks to reconstruct both breasts is the most expensive.
- Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover. Some insurance companies may pay for the entire procedure, including reduction surgery on the other breast to achieve symmetry. Others may pay only for reconstructing the affected breast because reduction surgery on the other breast is considered "non-essential,” which means you have to pay for the reduction. In some cases you may have to prove to your insurance company why reconstruction is needed. Your doctor's support, including a letter and other documentation, is essential.
- Did you have a lumpectomy that gave your breast a very different shape than it originally had? If you had a large portion of tissue removed during a lumpectomy, you might want to have reconstruction to restore a more balanced look. One study found that about 10%-30% of women who have a lumpectomy aren't satisfied with the way their breast looks after the procedure. Still, most women who have lumpectomies are happy with their breast's appearance and don't choose reconstruction.
- Do you have any other medical conditions that might affect your ability to heal after surgery? If you have diabetes, circulatory problems, or a bleeding disorder, it may take your body longer to heal from reconstruction surgery than it will for someone who doesn't have these conditions. Heavy smoking and drinking also can affect your ability to heal. All surgery leaves some scars, but the skin cells along your incision may die (a condition called necrosis) if your ability to heal is reduced. If you smoke, you may be required to quit smoking 2 or more months before reconstruction surgery so your body is better able to heal.
Dr. Marisa Weiss, president and founder of Breastcancer.org, has found that most of her patients prioritize reconstruction goals in the order below when making decisions:
- receiving the most effective anti-cancer therapy above and beyond anything else, including reconstruction
- the ability to function fully and comfortably after recovering from the reconstruction procedure
- aesthetics: the way the reconstructed breast feels and looks as far as size, shape, and symmetry with the other breast
- practical considerations: timing, cost, availability, length of recovery
It's also important to know that while breast reconstruction rebuilds the shape of the breast, it doesn't restore sensation to the breast or the nipple. Over time, the skin over the reconstructed breast can become more sensitive to touch, but it won't be exactly the same as it was before surgery.