Q: I had a mastectomy five years ago; can I still have reconstruction?
A: Yes! Delayed reconstruction can be done at any time: weeks, months or even years after your mastectomy. Your mastectomy incision will be reopened, through which a tissue expander or tissue flap will be inserted. Your mastectomy scar will be prominent across your new breast, but will fade considerably.
Q: Will I have prominent scars?
A: Every woman's reconstruction is different. Your reconstruction scars depend largely on how your mastectomy is performed, and when and how your reconstruction is done. Immediate reconstruction (performed at the same time as mastectomy) can often be accomplished with little or no visible scarring, while a delayed reconstruction (performed in a separate operation at some time after the mastectomy) leaves a pronounced scar across the reconstructed breast.
Q: I'm having a prophylactic mastectomy; can I still have reconstruction?
A: Just about any woman who has a mastectomy, whether for cancer treatment or to reduce her risk of developing breast cancer, can have reconstruction. Immediate reconstruction after elective mastectomy can produce excellent cosmetic results. And a study by the American Society of Plastic Surgeons found that women who have breast reconstruction after preventive mastectomy tend to have fewer complications related to the procedure. Ninety-eight percent stated that if they had it all to do over, they would make the same decision about mastectomy with immediate reconstruction.
Q: What if I don't want an implant?
A: Breast reconstruction can also be accomplished with a tissue flap, which uses skin, fat and sometimes muscle from elsewhere on the body (abdomen, thighs, hips or back, for example).
Q: Will I have a nipple after reconstruction?
A: In most cases, the nipple and areola are removed during mastectomy as a precaution against leaving lingering cancer cells behind. Once the new breast is created, a new nipple and areola can be recreated from a flap of skin on the breast (some surgeons prefer to use a skin graft) and later tattooed. Because reconstructed nipple lack nerves, they have no sensation.
Q: Can I keep my own nipples?
You're a candidate for nipple-sparing mastectomy if your tumor is small, non-aggressive,not in the skin or close to your nipple, or if you're having a preventive mastectomy to reduce your inherited risk for developing breast cancer. Although your breast tissue will be removed, your breast skin, including the nipple and areola will be preserved. Your breast tissue will be replaced with an implant or a tissue flap. Sensation and response may be diminished in preserved nipples.
Q: Is it safe to keep my own nipples?
A: Many women can, especially when their mastectomy is preventive. During your mastectomy, a tissue sample beneath the nipple is sent to a pathologist; if it is clear of cancer cells, nipple-sparing mastectomy is considered to be safe. If it is cancerous, the nipple is removed. You may still be able to keep your own nipples if your breasts are removed to treat cancer, and you meet certain criteria. Your nipples may not look the same or retain full sensation after nipple-sparing mastectomy.
Q: Can I have nipple-sparing mastectomy if my breasts are heavy and sagging?
A: You can, but your nipples won't be centered on your reconstructed breasts (much of your excess skin will be removed, as it would in a breast reduction, with enough skin remaining to accomodate reconstruction of your reconstructed breasts will which likely be higher on your chest). Having a breast reduction before your mastectomy can solve this problem.
Q: Which procedure will get me back to my normal routine in the shortest possible time?
A: Direct-to-implant breast reconstruction places an implant at the same time as your mastectomy. (This requires a nipple-sparing mastectomy.) Your breast surgeon removes your breast tissue, and while you're still asleep, your plastic surgeon will then insert your implant. This procedures requires no tissue expansion and recovery is quicker than tissue flap surgery. Your recovery will take longer if you develop an infection, need cosmetic revision or have other complications related to your implant or reconstruction.
Q: How closely will my reconstructed breast match my healthy breast?
A: The shape, size and position of your healthy breast can be closely matched, particularly if you have tissue flap reconstruction (natural tissue can be sculpted to match your health breast, while an implant cannot). Some women choose to have their opposite healthy breast augmented, reduced or lifted to get a better match.
Q: How do I find a good surgeon?
A: Ask for referrals from your oncologist, breast surgeon, friends, or other women who have had reconstruction. Your local breast cancer organization can also help. Check with the American Society of Plastic Surgeons to be sure the surgeon is certified, and always seek a second or third opinion. Ask each surgeon for referrals to previous patients. Use the listings on this website to find surgeons who perform direct-to-implant or perforator flap reconstruction.
Q: Will radiation affect my reconstruction?
A: In most cases it will, but to what degree depends on your breast skin and tissue that has been irradiated and the type of reconstruction you have. Because radiation impairs blood circulation and elasticity in the skin, it often compromises implant reconstruction, and is more likely to develop infection or heal slowly. Slow, conservative expansion sometimes works after reconstruction, but frequently it does not. Sometimes reconstruction with implants produces better results when it is performed before radiation. Some surgeons are seeing improved post-radiation results with implants by first adding fat grafts to the mastectomy site; this appears to reduce radiation-induced complications by surrounding the implant, which is added later, with a cushion of healthy tissue.
Tissue flap reconstruction is generally considered to be a better option for women who have already had radiation; this type of reconstruction fares better when performed after radiation: it brings living tissue to the irradiated site. Even a tissue flap can be affected by radiation, however. The new breast may feel harder or shrink as radiated tissue contracts.
Q: Will I have to delay my reconstruction until my chemotherapy treatments are completed?
A: The timing of reconstruction when adjuvant (after surgery) treatment is recommended is decided on an individual basis. Doctors used to routinely recommend delaying reconstruction until chemotherapy was completed. Now, in most cases involving adjuvant therapy, an expander or implant can be placed at the time of mastectomy, then completed after chemotherapy is finished. Flap reconstruction may be delayed, particularly if you need to begin chemotherapy as soon as possible.
Q: Will my insurance pay for my reconstruction?
A: By law, most group insurers who pay for mastectomy must also pay for reconstruction. An insurance company may impose restrictions on its coverage: it may pay only for reconstruction with in-network surgeons, for example, and restrict coverage to the types of reconstruction those surgeons provide.
Learn more about mastectomy and reconstruction, including surgery prep and recovery, choosing the right surgeon, and insurance issues