If you are considering breast reconstruction after your mastectomy, is your priority to have the shortest reconstructive procedure with the quickest recovery or the most natural breasts possible? Does keeping your own nipples appeal to you? Do you have excess fat in your tummy, hips, thighs, back or derriere that you’d like to be rid of in the process?
Today, breast reconstruction offers more choice than ever before, yet you may still have questions about the process and its outcome. How will your new breasts look and feel? How will they differ from your natural breasts? Can your new breasts be bigger, smaller, or the same size as your natural breasts? How long will surgery take and what should you expect from recovery?
The goal of reconstruction is not only to restore breast shape and volume, but to also create soft breasts with gently-sloped contours that look natural when you're clothed and when you're not. This is what good reconstruction does, although some results are better than others, depending on your surgeon, your physical makeup, and the procedure you choose.
No breast reconstruction is one-size-fits-all
After mastectomy, missing breast tissue can be replaced with breast implants, your own tissue, or a combination of both. Each procedure has advantages and disadvantages.
Regardless of the method, reconstruction is customized to accommodate your chest structure and the quality of your breast skin and tissue, and accomplish what you hope to achieve.
While breast reconstruction is imperfect—it can’t erase mastectomy scars, fully restore pre-mastectomy sensation, or reestablish your ability to breastfeed—it can soften the harshness of mastectomy, restore your shape, and enhance your feeling of physical wholeness.
Most reconstruction procedures involve three steps:*
The initial surgery forms the breast mound (a breast without a nipple).**
Later revision surgery adds the nipple and corrects asymmetry, position, and other cosmetic issues.
Optional tattooing of the nipple and areola completes the reconstruction. (Not required after nipple-sparing mastectomy.)
*The exception is direct-to-implant (see"Reconstruction with Breast Implants.")
**If you have nipple-sparing mastectomy, your reconstructed breast will include your natural nipple.
Reconstruction with breast implants
Using saline or silicone gel breast implants is the simplest method of breast reconstruction, and compared to reconstruction with your own tissue, it’s less invasive, leaves fewer scars, and doesn’t require advanced surgical skills. Recovery is also faster, although in most cases, the overall reconstruction process takes longer to complete.
At 31, I just couldn’t deal with having no breasts. If I had to have a mastectomy, I wanted to restore my breasts as closely as possible,
and that meant reconstruction.—Riley
Implants can be placed over or under the chest muscle.
Most breast reconstruction with implants involves tissue expansion, which uses a temporary inflatable implant to slowly stretch breast skin and/or muscle until a pocket is formed that is large enough to hold the implant in place.
Direct-to-implant reconstruction doesn't require expansion. A fully sized-implant is placed in the chest at the time of reconstruction. This is a one-step reconstruction that does not require additional surgery unless problems develop.
Although newer implants may last 15-20 years, eventually they need to be replaced (sometimes soon than later if problems occur).
Implants may rupture, wrinkle, contract, or have other inherent issues that often require re-operation.
Most reconstructive surgeons perform implant reconstruction.
Reconstruction with your own tissue
Autologous flaps of your own tissue can also be used to create breasts after mastectomy. Autologous reconstruction forms full-sized breasts during the initial operation.
A segment (called a "flap") of skin, fat, and sometimes muscle is moved from the donor site with its blood supply intact. It's then relocated in the chest and shaped into a breast.
Traditional autologous procedures sacrifice muscle. Advanced procedures preserve muscle, using only fat and skin.
Autologous procedures require more surgical skill than implant procedures. Muscle-sparing procedures require advanced surgical skills compared to muscle-sacrificing procedures.
A breast created from your own tissue feels more natural than one created with an implant.
Short-term complications are more likely to occur than long-term complications.
Studies show that breast reconstruction, whether it is performed with mastectomy or sometime later, greatly improves a woman’s sense of wholeness and well-being as well as her quality of life.
Informed decisions are the best decisions
It’s important to do your own research and make your own informed decisions about when, where, and how to have reconstruction, or whether you want to have it at all.
Not every option may fit your priorities, and you may not be a candidate for every alternative. Learning what is possible and what to expect will help you feel more in control of the process, so you can make the best decisions about what is right for you. The Complete Guide to Breast Reconstruction is a great soup-to-nuts resource.
Choosing the right surgeon influences your outcome more than any other factor. Not all surgeons perform every procedure, and the availability of different reconstructive methods (and the experience and skill of surgeons) varies widely.
More surgeons are experienced with traditional reconstructive procedures; fewer surgeons offer newer, improved procedures that require advanced surgical skills.
It is always a good idea to get a second or third opinion about how your breast reconstruction can be done, and to ask about a surgeon's experience.
It’s never too late to have breast reconstruction. A postponed or delayed reconstruction can be performed as a separate operation any time after your mastectomy has healed: 10 weeks, 10 months, or 10 years later.
If you have delayed reconstruction, your plastic surgeon will reopen your mastectomy scar to replace your missing breast tissue. The scar will remain on your new breast, but it will fade considerably in time.
Although delaying reconstruction results in additional surgery and recovery, it can provide additional time to consider your options and to experience a flat chest or what it is like to use breast prostheses.
Problems & Issues
Unexpected complications and setbacks can develop after any surgery, and breast reconstruction is no exception. While breast reconstruction rarely fails, plenty of women who have breast reconstruction have to deal with related problems. Some are temporary bumps in the reconstructive road that are easily improved or resolved; others may require more management, and in some cases, another surgery.
When problems linger beyond recovery or become severe, corrective steps can and should be taken. You don’t have to live with these issues. Most often, they can be resolved during revision surgery or in your surgeon’s office.
Reconstruction is Your Right
The Women’s Health and Cancer Rights Act (WHCRA) requires group health plans and individual health policies that cover mastectomy to also pay for:
Some plans are exempt, and out-of-pocket costs may apply. Government and church plans and some self-funded plans aren’t required to cover mastectomy or reconstruction, although many do.
The WHCRA stops short of guaranteeing your absolute choice as to how your breasts are reconstructed—it doesn’t set payment rates or guarantee payment for specific procedures, surgeons, or hospitals. Despite the law’s title, its protection isn’t limited to women or cancer patients. Men are also covered.
all stages of reconstruction of the breast on which the mastectomy has been performed
surgery and reconstruction of the opposite (untreated) breast to produce a symmetrical appearance
treatment of physical complications of all stages of the mastectomy, including lymphedema.