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Women Who Have Immediate Autologous Reconstruction Report Being More Satisfied With Breasts, but Have More Pain 1 Year After Surgery

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Many, but not all, women who have mastectomy to treat breast cancer go on to have one or both breasts reconstructed. There are many ways to reconstruct a breast. Tissue from the back, belly, buttocks, or other part of the body can be used to create a new breast. Doctors call this autologous reconstruction. Saline or silicone gel implants are another option. In some cases, an implant is added after autologous reconstruction.

Breast reconstruction can be done at different times, depending on what works best for a woman’s individual situation. When breast reconstruction is done at the same time as mastectomy surgery, it’s called immediate reconstruction. As soon as the breast is removed by the breast cancer surgeons, the plastic surgeon reconstructs the breast.

When breast reconstruction is done after breast cancer surgery or after any other treatments, such as radiation or chemotherapy, it’s called delayed reconstruction. There is also a staged approach, which is called delayed-immediate reconstruction. In this approach a tissue expander or implant is placed under the chest muscle and preserved breast skin immediately after the breast is removed. Once radiation is completed and the tissues have recovered (about 4 to 6 months), the expander or implant is removed and replaced with either your own tissue or a long-term implant.

The goal of immediate breast reconstruction is to optimize a woman’s quality of life and maintain her body image. She wakes up from surgery with a new breast (or breasts) and doesn’t have to wear a prosthesis or have a tissue expander in place for several weeks or months.

Doctors wanted to know how women perceived the outcomes of immediate breast reconstruction.

A study suggests that 1 year after surgery, women who had immediate autologous reconstruction were more satisfied with their breasts and had better sexual and psychosocial well-being than women who had immediate implant reconstruction. Still, women who had autologous reconstruction had more pain than they did before surgery.

The research was published online on March 27, 2017 by the Journal of Clinical Oncology. Read “Patient-Report Outcomes 1 Year After Immediate Breast Reconstruction: Results of the Mastectomy Reconstruction Outcomes Consortium Study.”

The study included 1,183 women who had been diagnosed with either invasive breast cancer or DCIS between February 2012 and July 2015. All the women were scheduled to have mastectomy and immediate breast reconstruction:

  • 69.8% had implant reconstruction
  • 30.2% had autologous reconstruction

All the women filled out a survey that asked about their:

  • satisfaction with their breasts
  • psychosocial well-being
  • sexual well-being
  • physical well-being, specifically the chest, upper body, and abdomen
  • quality of life
  • any symptoms or side effects they were having, including anxiety, depression, pain, sleeping problems, problems moving/functioning, and fatigue

The women filled out the survey twice: first, up to 30 days before breast cancer surgery and immediate reconstruction, and then again 1 year after surgery.

At 1 year after immediate reconstruction:

  • Women who had implant reconstruction had the same satisfaction with their breasts and psychosocial well-being as they did before surgery. Women who had autologous reconstruction were more satisfied with their breasts than before surgery and they had better psychosocial well-being.
  • Sexual well-being was better after surgery for women who had autologous reconstruction and worse for women who had implant reconstruction.
  • Both groups of women had worse physical well-being of the chest after surgery.
  • Women who had autologous reconstruction had worse physical well-being of the abdomen after surgery.
  • For both groups of women, anxiety and depression eased after surgery.
  • Women who had autologous reconstruction reported more pain that interfered with their daily lives after surgery.
  • Women who had implant reconstruction had less fatigue after surgery.

Overall, women who had autologous reconstruction were more likely to be more satisfied with their breasts than women who had implant reconstruction, as well as better psychosocial and sexual well-being.

These differences were all statistically significant, which means they were likely because of the type of reconstruction and not just due to chance.

“This study reveals an important unmet need in reconstructive breast surgery,” the researchers concluded. “Specifically, although current techniques may restore how a woman looks, they do little to address how she feels physically. As women increasingly choose mastectomy instead of breast-conserving therapy, it is especially important to share information about the PROs of the various options -- specifically, the physical morbidities associated with mastectomy and reconstruction -- during preoperative counseling. Much work remains to understand and improve physical well-being after mastectomy surgery.”

Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. If you’ve been diagnosed with breast cancer and are planning your surgery, you may decide not to have reconstruction, but it can be helpful to consider all your options.

Here are some questions you might want to think about as you're making your 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.
  • Is it important to you that your breasts look balanced when wearing a bra and bathing suits? 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.
  • In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes.
  • Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover.
  • 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, you might want to have reconstruction to restore a more balanced look.
  • 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 someone who doesn't have these conditions.
  • Do you have a condition that might give you a distorted image of your body? If you've been diagnosed with anorexia or bulimia, you may have a hard time accepting how your body looks in general, which may make it hard to accept how your reconstructed breast looks.

For more information, including types of reconstruction, the timing of reconstruction, and questions to ask your breast surgeon and plastic surgeon, visit the Breast Reconstruction section.

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