Brief answers to commonly asked questions about breast reconstruction after mastectomy. For more details, information and images, see The Complete Guide to Breast Reconstruction.
Q: How can your breasts be recreated after mastectomy?
A: Breast reconstruction use saline or silicone breast implants, your own natural tissue, or a combination of both to replace breast tissue that is removed during mastectomy. Just about anyone who has a mastectomy to treat breast cancer or reduce their high hereditary risk of developing it can have reconstruction. The length of surgery and recovery time varies depending on the procedure.
Q: Will I have prominent scars after reconstruction?
A: Breast reconstruction can’t erase scars created by previous breast biopsies or your mastectomy incisions, but if you have immediate reconstruction (performed at the same time as mastectomy), your new breasts may have little or no visible scarring. Delayed breast reconstruction (performed in a separate operation after the mastectomy) leaves a permanent scar across the reconstructed breast that fades over time.
Q: Is it safe to keep my nipples after mastectomy?
A: Nipple-sparing mastectomy (NSM) removes the breast tissue but preserves most of the breast skin, nipple and areola. The removed tissue is then replaced with a breast implant or your own tissue from elsewhere on your body. NSM is considered to be safe if your tumor is small, non-aggressive and not close to your skin or nipple. However, if cancer cells are found in the tissue directly beneath the nipple or areola during mastectomy, the nipple and areola will be removed. Your nipples may not look, feel or react the same after nipple-sparing mastectomy.
Q: Are saline or silicone breast implants better?
A: Compared to saline breast implants, which are filled with a saltwater solution, silicone gel breast implants are softer and more closely mimic the feel of natural breast tissue. Highly cohesive “gummy bear” silicone gel implants are less likely to rupture or leak, and if they do, they retain their shape. Silicone gel implants are more commonly used than saline implants for breast reconstruction.
Q: Which reconstructive procedure will give me breasts that are most like my natural breasts?
A: Autologous breast reconstruction (tissue flap reconstruction)—using excess fat and skin in your abdomen, thighs, hips, or buttocks—produces the most natural-looking and feeling breasts. Breasts created with your own living tissue are soft and warm, just as your natural breasts were.
Q: Which reconstructive procedure will get me back to my normal routine in the shortest possible time?
A: Direct-to-implant breast reconstruction places a full-sized breast implant in the chest at the same time as your mastectomy. (This requires a nipple-sparing mastectomy .) This “one-step” procedure requires no tissue expansion or revision procedures, and the surgery and recovery are shorter than reconstruction with a tissue flap. You may need additional surgery and recovery time if you develop an infection, need a cosmetic revision or have other complications.
Q: After unilateral mastectomy, 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. (A breast implant is a fixed shape, while natural tissue can be sculpted to match your healthy breast). Another option is to augment, reduce or lift the healthy breast to better match the reconstructed breast.
Q: I had a mastectomy five years ago; can I still have breast reconstruction?
A: Yes! Delayed reconstruction can be done weeks, months or even years after your mastectomy. Your mastectomy incision will be reopened, through which a tissue expander, breast implant or tissue flap will be inserted. Although your mastectomy scar will be prominent across your new breast, it will eventually fade.
Q: Will having radiation after mastectomy delay my reconstruction?
A: If you need to wait for post-mastectomy pathology results to determine whether you’ll need radiation therapy, your oncologist may recommend delaying your reconstruction until your radiation therapy has been completed and you’ve healed. In this case, you won't be able to have immediate breast reconstruction, but you might opt to instead have delayed-immediate reconstruction, a staged approach to rebuilding your breasts. When breast tissue is removed during a skin-sparing or nipple-sparing mastectomy, a temporary tissue expander is placed under the skin to temporarily preserve the breast shape. If your final pathology shows that you don’t need radiation, the expander can then be replaced with a breast implant or a tissue flap. If radiation is recommended, however, you’ll need to wait a few months after completing it before the expander can be replaced. You may be advised to delay breast reconstruction for 6 to 12 months after radiation if you have an increased risk of delayed wound healing or other complications from surgery due to underlying medical conditions.
Q: Will having chemotherapy after mastectomy delay my reconstruction?
A: Research shows that immediate breast reconstruction does not significantly delay chemotherapy treatment for individuals who don’t have underlying health conditions that increase the risk of infection or delayed wound healing. Delayed-immediate reconstruction is another option if you need to begin chemotherapy without delay: A tissue expander can be placed in your chest at the time of mastectomy, inflated while you have chemotherapy and then replaced with an implant or tissue flap when your chemo is finished. Talk to your oncologist and plastic surgeon about the best timing for your reconstruction, given your treatment plan and overall health.
Q: How do I find a good surgeon?
A: Ask for referrals from your oncologist and breast surgeon. Friends, family or others who have had breast reconstruction may also be helpful. Using the “Find a Plastic Surgeon Near Me” search tool at www.plasticsurgery.org is another option. Be sure the surgeon is certified (check certification with the American Board of Plastic Surgery (www.abplasticsurgery.org). Consult with two or three plastic surgeons who are experienced with the procedure you want before deciding which one is right for your priorities.
Q: Will my insurance pay for my breast reconstruction?
A: Federal law requires most group health insurers who pay for mastectomy to also cover the cost of breast reconstruction. (Many states have additional laws regarding breast 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.
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