Breast reconstruction: Your Choice
Whether your mastectomy is performed to treat or prevent breast cancer, and whether or not you choose to have reconstruction, knowing what to expect will help you prepare for the process and
help you to make the decisions that are best for you.
Unilateral mastectomy removes one breast; Bilateral mastectomy removes both breasts;
Prophylactic mastectomy removes a healthy breast to reduce breast cancer risk.
Mastectomy to treat breast cancer
Why is mastectomy recommended for some women and not for others?
Treatment is defined by:
Mastectomy is usually recommended if:
If you decide to have immediate reconstruction, your breast surgeon will perform a skin-sparing mastectomy, removing as much breast tissue as possible while leaving an envelope of breast skin intact. Once this is completed and while you are still under anesthesia, the reconstructive surgeon then refills the breast envelope with a temporary expandable implant, a full-sized implant, or a transferred flap your own tissue, depending on the reconstructive technique you have chosen.
Many women who have immediate reconstruction are candidates for nipple-sparing mastectomy. This procedure preserves your own nipple, although after surgery it may flatten, look different, or have less (or different) sensation as it did prior to mastectomy.* For carefully-screen candidates, nipple-sparing mastectomy does not increase the risk of recurrence.
Immediate reconstruction has advantages, but for some women, it's not the right choice. You may wish to forego immediate reconstruction if you want to avoid the added stress of researching options and making more decisions as you cope with a cancer diagnosis and treatment (you have more time to research your options if you are considering preventive mastectomy to reduce your risk of developing breast cancer). Your doctor may recommend that you complete chemotherapy or radiation before having reconstruction. Many women simply don't feel the need to have their breasts reconstructed.
If you do not have immediate reconstruction, after the surgeon removes your breast tissue, he/she will remove the excess breast skin and close the incision flat against your chest. Breast reconstruction is still possible at any time in the future, a month, a year, or even decades later. The mastectomy scar, however, remains, although it does fade considerably in time.
Some of the effects of mastectomy are permanent and irreversible, whether or not you have reconstruction. Removing breast tissue eliminates the ducts that produce milk, so after mastectomy you will be unable to breastfeed. Also, the breast and much of the surrounding area remains numb due to nerves that are severed when breast tissue is removed; the amount of sensation that returns varies, but generally, most women lose a great deal of sensation.
Learn more about mastectomy
Mastectomy to reduce an inherited predisposition
to breast cancer
The risk for developing breast cancer (and other cancers) is extraordinarily high for individuals who have a strong family history of breast cancer or an inherited mutation in either the BRCA1 or BRCA2 gene.
Prophylactic (preventive) bilateral mastectomy removes healthy breasts to reduce a woman's risk of breast cancer. It is the most effective method of combating a predisposition to the disease: remove most breast tissue and you remove most of the risk. Drastic and irreversible, preventive mastectomy is a deeply personal decision, and an act that is not right for everyone. In previvors (people who have a high hereditary risk of cancer but have not been diagnosed), preventive mastectomy is estimated to reduce breast cancer up to 90%, depending on an individual's personal risk factors. (A small risk remains because it is not possible to eliminate all breast tissue.)
Most women who choose to have their breasts removed to reduce their risk of breast cancer are candidates for nipple-sparing mastectomy that minimizes scarring and often results in no visible scars on the reconstructed breasts. Your own breast skin and nipples can be retained; your breast tissue is replaced with an implant or your own donor tissue.
Although preventive mastectomy is the most effective method of reducing high risk, other options for managing high risk including taking risk-reducing medication or choosing increased surveillance to detect breast cancer in its early stages.
A few things to consider about breast cancer risk:
Types of mastectomy
Radical (rarely used):
What is removed
Breast tissue, nipple, areola*
Breast tissue, nipple, areola, some or all lymph nodes, lining of the chest muscle
Breast tissue, nipple, areola, all lymph nodes, overlying skin, chest wall muscle
Breast tissue, nipple and areola are removed; most breast skin is preserved.*
Breast tissue is removed; most breast skin and the nipple are preserved.*
Breast tissue and nipple are removed; most breast skin and the areola are preserved.*
* Appropriate only with immediate reconstruction. Women who have tumors that are large, close to the skin or near the
nipple may not be candidates.
nipple may not be candidates.