If you’re interested in breast reconstruction after mastectomy, you’ll need to consider how your breasts will be recreated, what procedure to have, where your surgery will be done and which surgeon will perform your reconstruction. Deciding when to have your breast reconstruction is another consideration that’s just as important, if not more.
Breast reconstruction can performed along with your mastectomy, while you're still asleep on the operating table, or as a separate surgery anytime in the future.
Immediate breast reconstruction
Having breast reconstruction at the same time as mastectomy isn't a must, but it has definite advantages:
Most of your breast skin is preserved.
You may be able to keep your own nipples.
Your mastectomy incision will be placed in a less obvious location and may be completely hidden on your newly reconstructed breasts.
Mastectomy and reconstruction are performed in just one visit to the operating room, so you have a single recovery period.
You'll wake up with new breasts (unfinished or completed depending on the procedure you choose), so you never have a completely flat chest.
If you choose immediate breast reconstruction, your breast surgeon will perform a skin-sparing mastectomy or a nipple-sparing mastectomy, removing as much breast tissue as possible while leaving an envelope of your breast skin intact. Then, while you're still under anesthesia, your plastic surgeon will replace your breast tissue with a tissue expander (a temporary expandable implant, a full-sized breast implant or an autologous flap of your own fatty tissue.
Delayed breast reconstruction
Although most women who have breast reconstruction do so immediately (at the same time as their mastectomy), some choose to have reconstruction as a separate, later operation. Delayed breast reconstruction can be done any time after you’ve healed from your mastectomy—a few months or even a few years later. If you don’t have immediate breast reconstruction, your surgeon will remove your breast tissue and most of your breast skin, including the nipple and areola, leaving just enough skin to close the incision flat against your chest.
A future breast reconstruction is still possible. If you choose to have your breasts reconstructed at a later date, your plastic surgeon will reopen your mastectomy scar and replace your missing breast tissue with a tissue expander, breast implant or a tissue flat. Your mastectomy scar will remain on your new breast, although it will fade considerably in time.
Immediate reconstruction has advantages, but for some women, it's not the right choice. You may wish to forego immediate reconstruction if:
You’re unsure about breast reconstruction at the time of your mastectomy.
Your oncologist recommends completing chemotherapy or radiation before having reconstruction.
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 a health condition that precludes you from having another surgery.
You’d like to try wearing a prosthesis before committing to reconstructive surgery.
You simply don't feel the need to have your breasts reconstructed.
You’re pregnant.