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Breast Cancer: Should I Have Breast Reconstruction After a Mastectomy?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Breast Cancer: Should I Have Breast Reconstruction After a Mastectomy?
Get the facts
- Have breast reconstruction with your mastectomy or some time later.
- Do not have breast reconstruction. If you change your mind, you can have it done later.
Key points to remember
- Breast reconstruction may involve many different decisions, including when to have the surgery and what type of reconstruction to have. Be sure to understand your options, how long it will take to recover, and what kind of follow-up you will need.
- Most women are able to have breast reconstruction. But it may not be a good choice if you are obese, smoke, or have serious health problems, such as heart disease or diabetes. These conditions increase your risk of serious problems after surgery.
- It is important to be realistic about how your new breast will look and feel. The surgeon can show you pictures of other women who had the surgery you are considering. You can also ask to talk to women who have had the surgery.
- Making a decision about breast reconstruction can feel very stressful. But talking with your doctor or plastic surgeon will help you find your best options.
- If you choose not to have reconstruction or to wait, you can use a bra insert (prosthesis) to help your clothes fit better.
Breast reconstruction is surgery to rebuild the size and shape of a breast after your breast has been removed (mastectomy) because of cancer. It is done by a plastic surgeon. Your breast surgeon can refer you to a surgeon who has special training in breast reconstruction.
Reconstruction can be done at the same time as a mastectomy or at a later time. If you need to have radiation therapy after mastectomy, your breast reconstruction may need to wait until after you have finished radiation and the tissue has healed.
Before your mastectomy is scheduled, talk to your doctor about breast reconstruction. It would be best to decide with your entire medical team about when to have reconstruction. Your medical team may include your radiologist, surgeon, plastic surgeon, and medical oncologist.
A reconstructed breast will not look or feel just the way your breast did, but most women are happy with the results. To get an idea of what to expect, tell your surgeon that you want to:
- See pictures of other women who have had the surgery you are considering.
- Talk to women who have had the surgery to find out more about their experience.
Making a decision about breast reconstruction can feel very stressful. But talking with your doctor or plastic surgeon will help you find your best options.
There are two types of breast reconstruction:
- Breast implants. Implants may be filled with salt water (saline) or silicone gel. A fluid-filled implant may be placed right away, or a balloon (tissue expander) may be put in first. Over a few months, the expander is filled with saline until its size matches the other breast. Then the expander is removed and the implant is put in.
- Tissue flap surgery. The surgeon makes a new breast shape from skin, fat, and muscle taken from another area of your body (belly, buttocks, thigh, or back). There are several different types of tissue flap surgery. These surgeries are more complicated than putting in an implant, but the results look and feel more natural and last longer than implants.
If you want, the surgeon can also make a new nipple and areola (the darker area around the nipple). This is usually done 3 or 4 months after breast reconstruction to give the new breast time to heal.
Most women are able to have breast reconstruction. But some conditions increase your risk of serious problems after surgery. Talk to your doctor about whether breast reconstruction is possible for you if you smoke, are obese, or have a serious health problem such as diabetes.
If you choose not to have reconstruction or to wait, you can use a bra insert (prosthesis) to help your clothes fit better.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- Hospital stay for mastectomy and reconstruction is usually 1 to 3 days, depending on the type of reconstruction you have.
- You may have this done at the same time as your mastectomy or some time later.
- General anesthesia is usually used, so you sleep during the operation.
- If you have insurance that covered your mastectomy, it will probably also cover reconstruction.
- Some women say it helps them feel better about their bodies.
- As with any type of surgery, there is a risk of infection, usually in the first week or two after surgery.
- Problems can happen that require more surgery to fix. For
- The tissue used for a flap can die if blood supply to the tissue is not restored.
- Scar tissue around an implant can harden and squeeze the implant. This can cause hardening of the breast tissue and changes in the shape and look of the breast. This is more likely to happen in a breast that has been treated with radiation.
- Blood or clear fluid may collect in the wound.
- If the incisions don't heal right, the implant may become exposed. When that happens, the implant has to be removed.
- Other problems sometimes occur, such as pain or discomfort in the breast area.
- Silicone implants can leak inside the body without causing any symptoms. Women who get silicone implants should talk with their doctors about how often to have exams or tests to check the implants for leaking.
- Hospital stay may be 1 to 2 days for your mastectomy. Or you may go home the same day.
- Your chest will be flat where the breast was removed, and there will be a scar over the area.
- You can wear a bra insert to make your clothes fit better.
- You can choose to have breast reconstruction later.
- Some women may have negative feelings about the way they look without a breast.
Personal stories about breast reconstruction after mastectomy
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I kind of went into shock when my doctor told me I had breast cancer and would need to have my right breast removed. I started listening again when she described how I could have my breast reshaped. Knowing I could have this done right away before I even woke up from the mastectomy made the whole thing easier to deal with. I chose to have DIEP flap surgery, using tissue from my belly. I knew it would take awhile to heal and look like a breast, and I did have to have surgery on my left breast to help them match. But I am so glad I did it. It has helped me feel stronger after the trauma of cancer.
Claudia, age 42
When my doctor first mentioned that I could have my breast rebuilt after the mastectomy, I was kind of interested. I didn't know they could do things like that, taking tissue from your back or belly. But the more I thought about it, the more it didn't feel right for me. It seemed like a distraction when all I wanted to focus on was beating the cancer and getting back to my life. I talked to my husband about it, and he totally supported my decision. Maybe sometime down the road I might change my mind. But for now I use a prosthesis in my bra, and this works fine.
Patrice, age 51
I had my left breast removed 3 years ago and my right breast removed last year. I chose at that time to get implants on both sides. I have been pleased with the results. I swim every morning, and having the implants has helped me feel more balanced again. I feel so fortunate to live in a time when we have these options. My mother, who had breast cancer 40 years ago, was not so lucky.
Jewel, age 73
When I got cancer in one breast, I decided to have both breasts removed at the same time. I didn't have any type of reconstruction. There's nothing wrong with it, I just don't think you have to have breasts to be a woman. I am proud to be a breast cancer survivor (going on 6 years now cancer-free), and I use my story and my scars to help other women who are facing the same fight.
Kerry-Ann, age 45
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose breast reconstruction
Reasons not to choose breast reconstruction
I know I won't look the same as I did before, but I don't want to wake up from surgery without a breast.
I just don't feel up to facing more surgery at this point.
Having reconstruction will help me feel more like a cancer survivor and less like a cancer victim.
At this point I want to focus on fighting the cancer. I'll worry about the way I look later.
I am willing to commit to a lot of follow-up with my doctor to get a new breast.
I want to heal and move on as soon as possible. I'll wear a prosthesis.
I would not feel like a whole woman without a breast.
Being without a breast won't affect how I feel about myself as a woman.
I'm not worried about possible complications from reconstruction surgery.
I'm very worried about the possible complications from surgery.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having breast reconstruction
NOT having breast reconstruction
What else do you need to make your decision?
Check the facts
If I want to have breast reconstruction, it has to be done at the same time as my mastectomy.
- TrueNo, it's not true. You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later. It’s up to you.
- FalseCorrect. You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later. It’s up to you.
- I'm not sureYou may want to go back and read "Get the Facts." You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later.
If I don't have breast reconstruction, I can wear bra inserts to help my clothes fit better.
- TrueYou're right. Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
- FalseSorry, that's wrong. Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
- I'm not sureIt may help to go back and read "Get the Facts." Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
I might not be able to have breast reconstruction if I smoke, am obese, or have a serious health problem such as diabetes.
- TrueYes, that's correct. These health issues increase the risk of serious problems after surgery. If you have any of these, breast reconstruction may not be a good choice for you.
- FalseNo, this is true. These health issues increase the risk of serious problems after surgery. If you have any of these, breast reconstruction may not be a good choice for you.
- I'm not sureIt may help to go back and read "Get the Facts." These health issues increase the risk of serious problems after surgery.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Douglas A. Stewart, MD - Medical Oncology|