Your Breast Reconstruction Options after a Mastectomy

What is breast reconstruction?

Breast reconstruction aims to restore your breast to its natural form after a mastectomy. It has become an increasingly popular option over the last decade driven by greater awareness, better success rates and the inclusion of the procedure under some insurance plans.

What is involved in breast reconstruction surgery?

Breast reconstruction is a surgical procedure that restores the size and shape of the breast. While it can be done for cosmetic reasons, it is typically performed when one or both of your breasts have to be removed to treat cancer. The goal is to restore the look of the breast and match the size and shape to your other breast in just one surgery. If you feel that your breasts are uneven after surgery, a small procedure can be performed later to correct the discrepancies. If necessary, your surgeon can reconstruct your nipple and tattoo a new areola.

Do I really need it?

The decision to have breast reconstruction surgery after a mastectomy is a deeply personal one. The benefits of breast reconstruction are mainly psychological, including the improvement of self-esteem and confidence, but there are also some practical advantages, such as being able to fit normally into clothing without worrying about prosthetics.

How soon can I have breast reconstruction surgery after my mastectomy?

Talk to your surgeon before the mastectomy procedure to let them know you want to have breast construction surgery. They may recommend performing the reconstruction in the same surgical procedure as the mastectomy. This way you will only need to undergo surgery once. Having the surgeries at the same time will allow the breast skin and nipple to be preserved for the reconstruction. Having the reconstruction some time after the mastectomy is also possible, but there may be more scarring.

What are the different breast reconstruction options available?

Your surgeon will discuss with you about the choice of having an implant-based or tissue-based breast reconstruction.

Implant-based reconstruction

This can be done at the same time as the mastectomy and the implant is placed in immediately so you don't have to undergo a second surgery.

As with any surgery, there are risks. In the case of breast implants, the most common complications are:

• Infection – Being a foreign body, implants have a risk of getting infected, even in the future.
• Capsular contracture – a hardening of the scar tissue around the implant, which can occur years later
• Implant rupture – causing the liquid to leak from the shell.
• Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) – This rare form of lymphoma is associated with the scar tissue surrounding the implant. It is curable by removing the implant and scar tissue.

Tissue-based reconstruction

This procedure can also be done at the same time as your mastectomy but involves using your own body tissue so you end up with more natural-looking breasts that mimic the look and feel of your natural breast. The tissue is usually taken from your tummy and there are 2 types of procedures you could undergo: a TRAM flap and a DIEP flap.

TRAM flap

The flap is created by taking the tummy fat and skin, but leaving it attached to the abdominal muscle, and tunnelling under the skin to the breast. This can weaken your abdomen as the abdominal muscle is removed from its normal place.

DIEP flap

This procedure leaves your abdominal muscle in place and just transfers the skin and fat with the blood vessels. DIEP flap surgery takes about 7 – 8 hours and is usually performed by 2 surgeons.

The main risk of flap surgery relates to the tummy and the joining of the vessels. Also, the vessels supplying blood to the flap can become blocked and the tissue may die, but this happens in less than 2% of cases.

Which is best – implant or flap breast reconstruction?

Deciding on the type of procedure to undergo can be overwhelming, so talk to your surgeon about the differences and find out what is best in your individual case. It will depend on various factors, such as whether you need to go for radiation therapy, whether the surgery will be done at the same time as the mastectomy is performed, whether you feel you will be comfortable with an implant, and whether you qualify for reconstruction using your own tissue. If you opt for flap reconstruction, your surgeon will most likely take the tissue from your tummy or thigh area, or perform a fat graft, where fat is liposuctioned out and transferred to your breast. If taking fat from the tummy is a good option, you can benefit from a tummy tuck at the same time as the breast reconstruction, although you may have to go through a series of smaller operations.

What is the recovery process like and how long does it take to heal?

You can expect to have some swelling in the breast, which is normal and will resolve over a few months. After surgery, you may feel some mild discomfort and pain that can be alleviated with medication.

If you've had an implant, your recovery should be quick as there are no secondary surgery areas to look after. You will have a drainage tube inserted, which your surgeon will remove around 2 weeks after surgery.

If you've had a flap reconstruction, your surgeon will also need to monitor the area the tissue came from. You'll need to stay in bed for the first few days, but should be walking by the third day and your drains should be removed by the seventh day. You can expect to be back to your normal activities after a month.

Will my breasts be normal afterwards?

You will experience some loss of sensation due to nerve damage but you will be able to feel applied pressure to the breast. As long as the surgery is done well, no one will be able to tell that you have had the surgery unless they see your scars.

Can the breast cancer recur and will my surgery hide the returning cancer?

The chances of getting breast cancer in the other breast is higher than normal if you have had breast cancer in one breast, so be vigilant in conducting your own breast examinations regularly and attend all mammogram appointments. You won't need to have a mammogram on the reconstructed breast but your cancer can recur in the same breast, so monitor for new lumps. Your breast reconstruction won't hide cancer or be the cause of its recurrence.

How long does breast reconstruction last?

The effects of breast reconstruction are permanent if you choose to use your own tissue. There is no maintenance needed and the new breast should change naturally in the same way as your natural breast.

Breast implants won't change the look of your breasts over time unless you have complications such as rupture, hardening or deformation that may develop over time. Implants typically last about 20 years.

What should I look for in a good breast reconstruction surgeon?

You can start with the surgeon recommended by your oncologist. Speak to the surgeon to gain an understanding of their philosophy on breast reconstruction. If you are not comfortable with what they tell you, they may not be the right surgeon for you. If they seem a good fit, ask to speak to the surgeon’s other patients to understand their journey and experience.

The important thing is to find a surgeon you are comfortable with and that listens to your concerns. Your surgeon will naturally try to persuade you to choose a technique that they are more comfortable with, but remember that the end decision on what procedure to have, if at all, is yours.