Breast Reconstruction Surgery

Breast reconstruction surgery restores the shape and size of one or both breasts after a lumpectomy or mastectomy. Most people who get surgery for breast cancer are candidates for reconstruction. But it’s an extra step that not everyone chooses to take.

Decisions about breast reconstruction are very personal, so take the time you need to figure out the best options for you and your unique situation.

The most common kinds of breast reconstruction recreate the breast with tissue from another part of your body or with an implant. There are also types that use tissue from the breast area to form a smaller breast.

Breast reconstruction may include surgery on the other, unaffected breast, so the two breasts match in size and shape. 

Also, some people choose to do a more extensive reconstruction than others. For example, you could choose just to reconstruct the breast mound, or to get additional procedures to recreate the nipple or to fine-tune your results in other ways. And some types of breast reconstruction may be combined with procedures that can help restore sensation to the breast and nipples. 

There are several different types of breast reconstruction that are commonly done. The ones that may work best for you depend on factors such as your body type, goals for cosmetic results, cancer treatment plan, history of prior surgeries, and overall health.

In some cases, the first step of the breast reconstruction process is getting tissue expanders —  temporary breast implants that are gradually filled with salt water or air. These are used to stretch the skin and soft tissue, and to hold the space where an implant or tissue flap will later be placed.

 

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Some people are candidates for having breast reconstruction at the same time as mastectomy or lumpectomy, which is called immediate reconstruction. (When reconstruction surgery is done at the same time as lumpectomy, it may be called oncoplastic lumpectomy.) 

Breast reconstruction can also take place months or years after mastectomy or lumpectomy — this is often called delayed breast reconstruction.

The timing of breast reconstruction depends on a number of factors, including whether radiation therapy after breast cancer surgery is recommended for you.

If you’re thinking about having breast reconstruction or aren’t sure, here are some things you may want to consider to help you make the decision:

Is reconstructing your breast(s) important to you?

If you want a permanent breast shape and for your breasts to have a balanced, symmetrical appearance — whether you’re wearing clothes or not — reconstruction may be the best option for you. If you decide not to reconstruct your breasts but want a breast shape when you’re wearing clothes, you always have the option of wearing a breast form (prosthesis) — an insert that you put in your bra or bathing suit. 

Are you willing to have several surgeries to reconstruct your breast(s) over an extended period of time?

It’s common for multiple procedures to be needed to complete the initial breast reconstruction process. And you may also need other surgeries years later (for example, if you have breast implants that need to be periodically replaced). A plastic surgeon can outline the steps of any breast reconstruction so you know what to expect.

Do you want to resume your regular activities as soon as possible?

People who don’t have reconstruction are usually able to resume their daily activities much sooner than those who have reconstruction. Different types of reconstruction have different recovery timelines.

Are you an athlete or do you have a physically demanding job?

If so, full range of motion in both of your shoulders and your chest may be important to you. Some women find that implants, which are placed under or over the chest muscle, can limit their range of motion or be uncomfortable when reaching full range of motion. Certain flap reconstruction procedures cut through muscle in the back or lower abdomen, which can cause weakness or loss of function. A plastic surgeon can help you weigh the physical advantages and disadvantages of each type of reconstruction.

Do you have any other medical conditions that might affect your ability to heal after surgery?

If you have certain conditions such as diabetes, circulatory problems, or a bleeding disorder, your doctors may not recommend reconstruction, or may tell you that it will take longer to heal from reconstruction surgery. Also, if you smoke, you may be required to quit for a period of time before reconstruction surgery so your body is better able to heal.

A good place to start is by asking your breast surgeon or others who’ve had reconstruction for recommendations. You can also search the American Society of Plastic Surgeons’ directory of plastic surgeons to find a board-certified plastic surgeon who specializes in breast reconstruction in your area.

Plastic surgeons who do breast reconstruction have different skill levels and offer different types of reconstruction procedures. If you can, it’s helpful to meet with more than one plastic surgeon who has experience with the type of reconstruction you would like to have. During these consultations, you can ask questions about their expertise, what they would recommend for you, and what to expect from reconstruction surgery and recovery.   

Research shows that Black women face more barriers to getting breast reconstruction and may be less likely to have a consultation with a plastic surgeon. If you're a Black woman who is interested in having breast reconstruction, it’s critical to learn about all your options and to find a plastic surgeon you like working with.  

Like any surgery, breast reconstruction has possible risks and complications. Each type of breast reconstruction has different risks. The main risks and complications of implant breast reconstruction include infection, implant rupture or displacement, and capsular contracture. The main risks and complications of flap breast reconstruction include tissue necrosis, fat necrosis, and (for abdominal flap surgeries) hernia.

There are corrective breast reconstruction procedures you can opt for if you develop a complication or are not satisfied with the results of your breast reconstruction surgery.

Corrective surgery is always tailored to your specific situation. A plastic surgeon can recommend options based on what you’d like to change or fix. 

Many but not all health insurance plans in the United States cover breast reconstruction after mastectomy or lumpectomy. Contact your insurer to find out the specifics of coverage under your plan. It’s important to find out in advance what your out-of-pocket costs for breast reconstruction will be, including any co-pays and deductibles.

After you’ve had breast reconstruction, whether you also need to continue getting regular mammograms or other imaging tests for screening depends on factors such as the types of surgery you had, your individual risk factors, and your age. Most people who’ve had a double mastectomy don’t need to continue to get screening mammograms, unless their doctors think they’re at high risk of recurrence. But if you had a lumpectomy or a single mastectomy, you generally do need to continue getting screening mammograms. If you have breast implants, mammograms might be done slightly differently.

Breast reconstruction isn’t right for everyone. After a mastectomy, you may prefer to leave one or both sides of your chest flat rather than have the breast or breasts recreated. This is called going flat. Studies show that there is no difference in quality of life, body image, or sexuality between people who have breast reconstruction and people who go flat. Doctors sometimes assume that everyone wants breast reconstruction after breast cancer surgery and don’t always offer going flat as an option. You may have to start the discussion with your doctors and advocate for yourself if you want to go flat.

 

This information made possible in part through the generous support of www.BreastCenter.com.