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More Women Having Reconstruction After Mastectomy

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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.

Like any surgery, breast reconstruction has both benefits and risks. recommends that you talk to all of your cancer doctors and your plastic surgeon about the best options for your unique situation. When you have all the information, you can make a decision that is right for you and your personal preferences.

A report from the Agency for Healthcare Research and Quality (AHRQ) has found that breast reconstruction after mastectomy rose 62% from 2009 to 2014.

The report was published online on Oct. 11, 2017. Read “Statistical Brief #228: Breast Reconstruction Surgery for Mastectomy in Hospital Inpatient and Ambulatory Settings, 2009-2014.”

To write the report, the researchers analyzed information from medical record databases in 22 states. The data represented about 60% of the United States population and are for women age 18 and older.

In 2009, 21.7 women per 100,000 women had reconstruction after mastectomy. In 2014, 35.1 women per 100,000 women had reconstruction after mastectomy.

Women in all age groups generally had more breast reconstruction, but the increase was the largest for women age 65 and older, women covered by Medicare, and women who had no insurance.

The report said the increase in reconstruction rates was due to:

  • More reconstruction surgery being done at outpatient facilities: reconstruction surgeries done at outpatient centers increased more than 150% from 2009 to 2014 while rates of reconstruction surgeries done as inpatient procedures stayed the same.
  • More reconstruction surgery being done as a separate surgery after mastectomy surgery: in 2009, 61% of reconstruction was done as a separate surgery; in 2014, 71% of reconstruction was done as a separate surgery.

Compared to white and Hispanic women, Black women were more likely to have reconstruction surgery done at the same time as mastectomy surgery.

Henry Kuerer, M.D., executive director of breast programs at MD Anderson Cancer Network in Houston, said in an interview that he was "particularly pleased to see that prior evidence that Black women were not receiving breast reconstruction as often as white and Hispanic women appears to have turned around. Whenever the word mastectomy is mentioned by a surgeon, the next words need to include the possibility of 'breast reconstruction.' Whether best performed immediately versus delayed has to do with multidisciplinary team discussions regarding subsequent treatment needs including radiotherapy."

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.

It’s important to talk to all of your cancer doctors and your plastic surgeon about the best options for your unique situation. Talking to a plastic surgeon who is experienced in the options you’re considering may give you the most complete review of all your choices. When you have all the information, you can make a decision that is right for you and your personal preferences.

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.

Talking to other women who have had breast reconstruction can give you more personal opinions about your options. There’s nothing like hearing from other women who’ve had it done -- and they may even be willing to share photos. Some great places to go are the 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."

For much more information, including types of reconstruction and the timing of reconstruction, visit the Breast Reconstruction pages.

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