Breast Reconstruction After Cancer

Breast cancer changes a woman in many ways— one of which may be the loss of one or both breasts by mastectomy. The decision to have breast reconstruction surgery is a personal one. While there are several options, undergoing surgery to rebuild the breasts is one that you may wish to consider carefully.

Your team of breast cancer specialists at Willamette Valley Cancer Institute and Research Center can walk you through your breast reconstruction surgery options. They can explain how deciding before your breast cancer surgery can play a role in your overall cancer treatment plan.

What is Breast Reconstruction?

Breast reconstruction restores one or both breasts to near-normal shape, appearance, symmetry, and size following breast cancer surgery. It often involves multiple procedures performed in stages. It can either begin at the time of mastectomy or be delayed until a later date, such as after radiation therapy (if it’s part of your breast cancer treatment plan).

There are a few options when it comes to how breast reconstruction can be done. 

  • One option is for your breast(s) to be rebuilt using implants (saline or silicone). 
  • Another is for them to be rebuilt using autologous tissue (tissue from elsewhere in the body). 
  • Sometimes, the breast is rebuilt by using implants and autologous tissue in combination with one another. 

It’s important to understand that while breast reconstruction rebuilds your breast(s) shape, it does not restore the breast or nipple’s sensation. Eventually, the skin over the reconstructed breast may become more sensitive to touch, but it won’t be the same as it was before your breast cancer surgery.

If you are thinking about breast reconstruction, you must talk with a plastic surgeon specializing in breast reconstruction. You should meet with the plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on. Your WVCI breast cancer doctors can offer suggestions for plastic surgeons. The type of reconstruction that is best for you will depend on various factors, including your age, body type, and cancer surgery type. The plastic surgeon can explain the risks and benefits of each type of reconstruction.

Types of Breast Reconstruction Procedures

When it comes to breast reconstruction, there are different techniques to choose from— some of which may require more than one operation. Talking with your WVCI oncologist and the plastic surgeon who will perform the reconstruction can help in the decision-making process.  

Generally, breast reconstruction falls into two categories:

  1. Implant reconstruction, which uses silicone or saline breast inserts known as breast implants to help form a new breast
  2. Autologous or “flap” reconstruction, which uses tissue from another part of your body (such as your belly, thigh, or back) to form a new breast 

As with most other medical procedures, there are pros and cons to consider when thinking about either of these techniques. For example, implant reconstruction is a relatively short procedure, but implants don’t hold up as well as using your own tissue. This means another surgery to remove or replace your implant will most likely be needed later on— usually within ten years, according to The American Cancer Society.

The autologous procedure, on the other hand, is a longer operation. However, because you are using your own tissue, it should last a lifetime.

If both of your breasts were removed in a bilateral mastectomy, then implants are an easier option because they will be the same size and shape. If only one breast needs to be reconstructed, then a flap surgery may make it possible to better match the other breast’s shape and size. There are some situations in which the surgeon will recommend altering the second breast, even if it was not included in the mastectomy surgery, to make them look similar.

Whether or not you reconstruct your nipple is another choice. Nipple reconstruction options include nipple/areola tattooing and fat grafting. Although the reconstructed nipple and areola do not have any sensation, it can help the reconstructed breast look more like the original breast.

Breast Reconstruction Alternatives

As mentioned earlier, breast reconstruction isn’t for everyone. Many women decide not to have their breasts rebuilt at all. For some, the thought of a second surgery isn’t appealing. For others, they are simply comfortable with their new look. Sometimes, the cost is an issue, especially for women who don’t have extensive insurance coverage. 

If you decide against breast reconstruction after removing the cancer, you have two main options:

  • Using a breast form or prosthesis (inside the bra or attached to the body to wear under their clothes)
  • Going flat (not wearing a breast form)

Your WVCI breast cancer specialist will be happy to discuss the pros and cons of both alternatives with you.  

Immediate vs. Delayed Reconstruction after Breast Cancer Treatment

When breast reconstruction is done often depends on what works best for your situation. 

Many women choose an approach called immediate reconstruction, which occurs at the same time or just after the mastectomy surgery. Although immediate reconstruction has become the standard care for most patients, there are times when it may not be possible. 

Others who need additional treatment, such as chemotherapy and radiation, may be advised by their breast cancer specialist to hold off until all treatment is complete. This is called delayed reconstruction. Depending on your situation, this delay can occur months or even years after mastectomy. 

Is Breast Reconstruction Right For You?

Breast reconstruction is a very personal decision and a process that takes time. Don’t hesitate to ask any questions you may have with your breast cancer doctor at Willamette Valley Cancer Institute, and talk to your family members, including your spouse or partner, to help weigh out your options. We are here to answer any questions about breast cancer you may have and can point you toward resources that offer valuable information to help you choose.
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