Managing Treatments

Breast Reconstruction After Mastectomy: How to Decide It’s Right for You

There are many options to consider when making a decision about breast reconstruction after a mastectomy. Talk to your treatment team if you're interested.

Cancer takes away a lot of things, including a sense of control in your life. Breast reconstruction after mastectomy is one of the ways you can get some feeling of ownership over your body when you feel defeated.

Breast reconstruction is a means of restoring the shape of the breast after a mastectomy, where the entire breast is removed, or after a lumpectomy, where a portion of the breast is removed.

Is It Right for You?

There are a number of reasons why you may choose this treatment. Those include:

  • It can help you feel whole again.
  • It can restore that fat layer to the chest area to make it more comfortable (which also makes it easier to snuggle your children).
  • It can make your clothes fit better.
  • It can boost your confidence in sexual interactions.

Reconstruction is not the right choice for everyone. For some women, it’s not medically advisable. Some women prefer the ease of remaining breastless. More often it’s a matter of not wanting any more surgery. There’s no need to go through the surgery if it’s not a change that’s important to you.

Types of Reconstruction

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that requires insurers that cover mastectomies to also cover breast reconstruction surgeries, with few exceptions. This also includes procedures to make adjustments to the non-cancer breast to help your breasts match.

Generally, types of reconstruction fall into two categories. There are implants, such as saline or silicone packets, that are used to recreate the breast. Implants generally have the quicker recovery time, according to the American Cancer Society. The other category of reconstruction is the flap, where your own body material is used to recreate the breast.

In some cases, these surgeries involve moving or cutting muscle, but newer procedures have been developed that allow doctors to move the fat and blood vessels without disturbing the muscle. There’s an array of flap procedures that take the donor material from areas such as your abdomen, buttocks or inner thigh. Additionally, doctors may use a procedure called fat grafting, as Breastcancer.org details, where they fine-tune the shaping of the new breast with fat extracted by liposuction.

What to Expect

It’s best to consider reconstruction options before your mastectomy, if possible. In many cases, the reconstruction is performed in the same surgery as the mastectomy. This is called immediate reconstruction, according to Breastcancer.org. In other cases, the surgeon may perform some prep work for the reconstruction during the mastectomy, called delayed-immediate, or it can be performed after treatment, known as delayed reconstruction.

Skin-sparing mastectomies will preserve skin to cover the new breast when it’s created, according to the Mayo Clinic. Depending on your type of breast cancer, you may be able to have nipple-sparing mastectomies. Additionally, during the mastectomy, surgeons can place a type of implant called an expander. Over a period of several weeks, a small amount of saline is injected into the expander, your skin grows to accommodate and more saline is injected the next week to stretch your skin to a size that will accommodate an implant or flap reconstruction.

You may need to allow your skin to recover for as much as a year after radiation treatment before having your breasts reconstructed. There’s no rush to complete the reconstruction. It can be completed when you’re ready and it fits your schedule.

Breast reconstruction after mastectomy is considered part of breast cancer treatment. The reconstruction process can be a respite from the chaos and trauma of cancer and allow you to start to feel at home again in your body.

Watch a video interview with UVA plastic surgeon, Kant Lin, MD, talking about reconstructive surgery.

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Judy Schwartz Haley
Judy Schwartz Haley