Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. Researchers are studying how different reconstruction techniques, as well as the timing of reconstruction, affect reconstruction outcomes, both emotionally and physically.
There are three ways to time reconstruction after mastectomy:
- Right after mastectomy, before any other treatments such as chemotherapy and/or radiation therapy. This approach is called immediate reconstruction.
- After surgery and after any chemotherapy and radiation therapy are done. This approach is called delayed reconstruction.
- A two-step approach involving some reconstructive surgery during mastectomy and more reconstructive surgery after any additional treatments. This is called delayed-immediate reconstruction.
There are two main techniques for reconstructing the breast:
- Inserting an implant that's filled with saline (salt water) or silicone gel. In many cases, your plastic surgeon places a tissue expander either under the pectoral chest muscle or on top of the pectoral chest muscle after your breast surgeon has removed the breast tissue. A tissue expander is a balloon-type device that stretches the skin to make room for the implant. The expander has a port (a metal or plastic plug, valve, or coil) that allows the surgeon to add increasing amounts of liquid (a salt water solution) over time (between 2 to 6 months) until the skin is gradually stretched enough to accommodate the implant.
- Using tissue transplanted from another part of your body (such as your belly or back). This is called autologous reconstruction.
A small study found that poor outcomes or severe complications were more likely with immediate implant reconstruction followed by radiation therapy than with immediate autologous reconstruction followed by radiation therapy. Most of the women in the study who choose autologous reconstruction had a TRAM flap. TRAM stands for the transverse rectus abdominis muscle, which is in the lower abdomen, between the waist and the pubic bone. With the TRAM procedure a "flap" of this abdominal tissue is moved to the chest area to reconstruct the breast.
- 33% of the women who had immediate tissue expander/implant reconstruction followed by radiation had a severe complication that required more surgery or antibiotic treatment. None of the women who had immediate autologous reconstruction followed by radiation had these severe complications.
- 55% of the women who had immediate tissue expander/implant reconstruction followed by radiation had problems moving their arm or couldn't lift an object (this is called a poor functional result). Only 9% of the women who had immediate autologous reconstruction followed by radiation had these problems.
- Only 51% of the women who had immediate tissue expander/implant reconstruction followed by radiation said the breast reconstruction was cosmetically acceptable. More than 82% of the women who had immediate autologous reconstruction followed by radiation said the reconstruction was cosmetically acceptable.
If you're considering breast reconstruction, talk to your doctor about the options that make the most sense for you. Here are some sample questions you might want to ask:
- Which reconstruction timing choice is best for me? Immediate reconstruction can be a good option, but if your treatment plan includes radiation and chemotherapy, your doctor may recommend delayed or immediate-delayed reconstruction.
- Which type of reconstruction is best for me? Each type of implant and autologous reconstruction has its own benefits and potential side effects. The best approach for you will depend on your individual circumstances and your preferences.
- Who should do the reconstruction? Most plastic surgeons who do breast reconstruction have experience with the different breast reconstruction options, but that experience may be stronger with some approaches. If you choose immediate reconstruction, it's important to choose a plastic surgeon who can work well with your breast surgeon.
Visit the Breastcancer.org Reconstruction section to learn much more about reconstruction options you and your doctor can consider.
Editor's Note: This article was updated on Aug. 29, 2019, with more current information about breast implant reconstruction.