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Breast Reconstruction after Mastectomy

By Traci McCormick, M.D., radiation oncologist at Alliance Cancer Care

What is Breast Reconstruction?

If you have breast cancer, your doctor may recommend you have a mastectomy. Mastectomy is the removal of the entire breast to treat breast cancer.  Following a mastectomy, the process of “reconstruction” involves creating the shape and look of the breast for cosmetic purposes.  This is not the same as breast augmentation or “implants,” since the breast tissue is removed. 

Types of Breast Reconstruction

Following a mastectomy, there are two primary ways that breast reconstruction can be done. These are implant reconstruction and tissue flap reconstruction.

Implant Reconstruction

During implant reconstruction, a saline or silicone implant is used to recreate the breast tissue. While some women can have implant reconstruction during mastectomy, others require a two-stage process, with a tissue expander during the first stage followed by the permanent implant after the tissue expander stretches the tissues enough for the implant to be placed.

Tissue Flap Reconstruction

In tissue flap reconstruction, skin and soft tissue flaps from your own body are used to reconstruct the breast.  It is most common to take tissue from the abdomen for the reconstruction, but tissue from the back, thigh, or buttocks can also be used.  This procedure is more complicated than implant reconstruction, but the results often mimic the look of a natural breast more than reconstruction with implants.

What is the Best Timing of Reconstruction?

As radiation oncologists, we are asked most about the timing of reconstruction and the effects of radiation on the reconstruction.  There are pros and cons to each and the options should be thoroughly discussed with your treatment team.

Delayed Reconstruction

Delayed reconstruction refers to waiting to do the reconstructive surgery until after the radiation is over.  This lowers the chances that radiation will affect the cosmetic outcome of the reconstructive surgery.

Immediate Reconstruction

Immediate reconstruction is when reconstruction is done at the time of mastectomy.  For those women that will not need radiation, this is usually preferred.  For women who will be getting radiation, it is possible to go ahead and place a tissue expander at the time of surgery.  Once radiation is over, the expander can be removed and an implant can be placed.  We often recommend a period of waiting after radiation to allow for healing before your tissue expander is “exchanged” for the final implant. It is also possible for flap reconstruction to be done at this time.

Should you undergo reconstruction?

Only you can decide if breast reconstruction is the right choice for you, but here are a few things to consider when making the decision:

  • How important is it to you to have the look of a breast?
  • If you only have a mastectomy on one breast, how important is it to you for your breasts to look even or balanced?
  • How many surgeries will be involved in the reconstruction? Are you willing to go through multiple surgeries?
  • How important is maintaining your full range of motion? Some women find that after reconstruction, their range of motion in their shoulder and chest is limited.
  • Will there be significant costs associated with reconstruction?
  • Do you have other medical conditions that may affect your ability to heal after surgery?

Dr. Marisa Weiss, chief medical officer of Breastcancer.org, has found that most of her patients prioritize reconstruction goals in the order below when making decisions:

  1. Receiving the most effective anti-cancer therapy above and beyond anything else, including reconstruction
  2. The ability to function fully and comfortably after recovering from the reconstruction procedure
  3. Aesthetics: the way the reconstructed breast feels and looks as far as size, shape, and symmetry with the other breast
  4. Practical considerations: timing, cost, availability, length of recovery

Risks associated with reconstructive surgery

The risks associated with reconstructive surgery may include:

  • Infection
  • Bleeding
  • Blood clots
  • Wound healing problems
  • Unexpected scarring
  • Fatigue
  • Tissue death (necrosis) of all or part of a tissue flap, skin, or fat
  • Problems with the implant, including wrinkling and rupture
  • Weakness, pain, or sensitivity at the donor site after flap reconstruction

It is also important to note that reconstruction does not restore sensation to the breast or nipple.

Am I a candidate for breast reconstruction surgery? 

While most women are candidates for breast reconstruction, some general contraindications include severe cardiac or lung disease, collagen vascular disease, extreme obesity, older patients, smokers who are unwilling to quit, and prior surgery that has interrupted the blood supply to potential flaps.

It is important for you to discuss your medical history with your surgical team before deciding to undergo reconstructive surgery.