Breast Cancer: Breast Reconstruction After Breast Surgery
What is breast reconstruction?
Breast reconstruction is surgery to
create a new breast shape in place of a breast that has been removed (mastectomy).
can be done with implants or with tissue from another part of your body. Sometimes
are used to rebuild a breast shape. The breast mound created comes as close as possible
to the shape and look of a natural breast.
Surgery may be done to reconstruct
either 1 breast (unilateral) or both breasts (bilateral). The goal of the unilateral
reconstruction is to create a breast mound that matches the other breast. If both
breasts have been removed, the goal of the surgery is to create both breast mounds
the size of the woman’s natural breasts.
Making a decision about breast reconstruction
The decision to have breast
reconstruction is a very personal one. It depends on how you think you’ll feel after
mastectomy. If you think you would feel uncomfortable with a flat chest or wearing
false breast (prosthesis), you may want to consider breast reconstruction. If you
want to have any more surgeries, you may not want to do it.
If you’re thinking of having breast
reconstruction, talk with your healthcare provider about it before your mastectomy.
healthcare provider can tell you if reconstruction is an option for you. You can also
talk about which type of reconstruction surgery might be best for you.
Your healthcare provider will talk
with you about factors that can affect your surgery options. These include:
- The size of your breasts
The size of the cancer and
its location in your breast, which affects the amount of skin and tissue to be
removed during the mastectomy
The amount of tissue removed
from your breast and chest
Whether you’ll need more
treatment after surgery, like radiation therapy, which can affect wound
- Your willingness to have more than 1 surgery
Your overall health and
health history (for instance, if you smoke or your chest tissue has been damaged
by radiation therapy, you may not be able to have reconstruction surgery)
- Your insurance coverage and possible out-of-pocket costs
When is the best time to have breast reconstruction?
Talk with your healthcare
provider before your mastectomy. You may meet with a plastic surgeon. This is the
healthcare provider who does the reconstruction surgery after the mastectomy is done.
Your healthcare providers will then talk with you about your options for:
Immediate reconstruction. This is reconstruction surgery done at the same
time as the mastectomy.
Delayed reconstruction. This is a surgery done after you recover from the
mastectomy. If radiation therapy is part of your treatment plan, you may be
advised to wait until after the radiation is finished.
Here are some things to keep in
mind about the best time to schedule your surgery:
emotional and psychological well-being.
Some experts suggest that waking
up from a mastectomy with the reconstruction already done is less traumatic than
waking up without a breast. This varies greatly from woman to woman.
other treatments you are having.
If you’re getting radiation after your
surgery, you may need to delay breast reconstruction. Radiation to the
reconstructed breast can increase the chance of problems, like infection and poor
Recovery time. Having reconstruction surgery at the same time as your
mastectomy may mean you’ll recover from both surgeries at the same time.
condition of your skin.
If your skin isn’t ready for the stretching that
goes on during reconstruction, you may need to have it done later on. For example,
the skin of women who smoke or who have diabetes may need extra healing time
The overall surgery plan. Breast reconstruction can
involve many surgeries over a period of time to complete the reconstruction. Be sure
to discuss this with your surgeon so you know what to expect.
Common risks of breast reconstruction
Any type of surgery has risks. The
risks of breast reconstruction include:
Fluid collection in the
surgical area (seroma)
Problems with the sleep
medicines (anesthesia) used during surgery
Bruising and swelling
Problems with breast
- Possible future surgery, such as to replace a breast
The most common complication of
breast reconstruction done with implants is called capsular contracture. This is when
the scar tissue (capsule) around the implant
tightens. It can make the breast mound feel hard and change the shape. In some cases,
second surgery is needed to fix this problem.
What are the different types of breast reconstruction?
There are 2 main types of reconstruction surgery:
Expander-implant. This method uses an expander that’s filled over time to
slowly stretch the skin to create a breast mound. This may be followed by the
placement of a permanent breast implant.
Autologous tissue. This method uses your own body tissues to reconstruct
a new breast mound. These reconstruction surgeries leave you with 2 surgical
wounds: your chest and the site where tissue was removed.
In some cases, you may have a
combination of both types of reconstruction. You may also decide to have other
procedures to improve how your new breast shape looks. For instance, you might decide
have reconstructive surgery on your other breast so that it matches your new breast
shape. Or you may want to have a nipple or areola reconstructed.
Expanders are empty silicone
“envelopes” put under the pectoralis muscle during the mastectomy surgery. This
muscle is between the breast and the chest wall. The expander is filled with saline
solution or air over several weeks. This is done to slowly and gently stretch the
skin and soft tissues of your chest. The saline or air is injected into the expander
through a valve or port in the expander that lies just under the skin. This is done
over many weeks.
Once the expander has been
completely filled, it’s left in for several more weeks to months. This allows for
maximum skin and soft tissue growth. Once your chest tissues are ready, a second
surgery may be done to take out the tissue expander and put in the permanent implant.
Sometimes, the expander is just left in place.
Implants are envelopes filled
with liquid or silicone gel. They’re put under the breast tissue and used to form
shape of the breast. Each type of implant has pros and cons. Your healthcare provider
will discuss the types of implants with you and help you decide which to use.
Autologous tissue surgery
This surgery moves tissue from
another part of your body and uses it to make a breast shape. There are different
ways to do this surgery, such as:
TRAM (transverse rectus abdominous muscle) flap. An area of fat, skin,
and muscle is removed from your belly (abdomen) and moved to the chest. This
surgery gives you a tummy tuck. TRAM flaps may change as you gain and lose
weight. It’s important to know that removing stomach muscle can increase stress
on the back, weaken your stomach muscles, and put you at risk for developing a
hernia. This type of surgery leaves a horizontal scar across the lower abdomen
plus a scar on your chest.
DIEP (deep inferior epigastric perforator) flap. With this surgery,
the surgeon takes fat and skin (but not muscle) from your lower belly and moves
them to your chest. This surgery also gives you a tummy tuck.
Gluteal free flap. The surgeon removes part of the skin, muscle, and
fat from your buttocks, and grafts it onto the chest. This is a more complex
surgery. It’s not offered at all surgical centers.
Latissimus dorsi flap. For this surgery, muscle, fat, blood vessels,
and skin are moved from your upper back to your chest. Sometimes an implant is
also needed with this surgery.
(transverse upper gracilis) flap.
In this type, muscle and fat is taken
from the upper, inner thigh and moved to the chest. This newer surgery may not
be available near you.
Healing after surgery
Immediate reconstruction surgery
tends to have a longer recovery time than for mastectomy alone. Recovery from delayed
reconstruction is much quicker. With autologous tissue surgery, there’s a second surgery
site that will need to be cared for as it heals.
It’s important to know that it can
take up to a year before the final results of breast reconstruction can be seen. Try
be patient as your body heals.