Breast Reconstruction After a Mastectomy: You Have Options

There are many decisions to make after having one or both breasts removed during a mastectomy, including whether you have reconstruction, what type to have and when to have it.

It’s estimated that 40 percent to 50 percent of breast cancer patients choose to have reconstruction after a mastectomy. A recent survey for the American Society of Plastic Surgeons found that many women lacked adequate information about their options – including the fact that federal law requires insurers to cover the cost of reconstruction.

With that mind, let’s take a look at the most common reconstruction options as well as factors that might influence the timing of the procedure.

Implant-Based Reconstruction

These procedures involve the same implants – saline or silicone based – used in cosmetic surgery. The reconstruction can be done at the same time as your mastectomy, though women often choose to have the procedure done at a later date. If it isn’t done immediately, a device called a tissue expander – it slowly expands over time – can be inserted to help prepare for the later procedure.

This is the most common choice, with a shorter surgery and quicker recovery time when compared with the tissue-based approach. It is also usually the only option if you want to have the procedure performed immediately following the mastectomy.

The implant typically lasts 10 to 20 years before it needs to be replaced. One factor to consider is that the reconstructed breast won’t look or feel like the natural, opposite breast. This will become more noticeable over time, as the natural breast changes with age. This, however, is not an issue for women who choose to have the healthy breast removed in what’s known as a preventive or prophylactic mastectomy. Both breasts can then be reconstructed at the same time, with a better chance of matching.

Tissue-Based Reconstruction

Tissue-based reconstruction uses your own body tissue – skin, fat and muscle – to create a new breast. The tissue is taken from an area known as the donor site. That’s often the abdomen, though tissue may also be taken from the back, buttocks or thighs.

This is the more complicated option since it involves a second surgical procedure to harvest the tissue for the flap. The surgery takes considerably longer: up to 10 hours, compared with one to two hours for an implant. This also means a longer recovery time.

Perhaps the biggest advantage of this approach is that it can create a breast that is closer to the feel and shape of the natural, opposite breast. It’s also possible to combine the tissue-based and implant-based options to create a breast that better matches the other breast. This combined approach may be necessary if there’s not enough tissue available at the donor site.

Reconstruction Timing

If you’ve chosen to have reconstruction, you also need to decide whether to have it done later or as part of the mastectomy – with your plastic surgeon stepping in after the cancerous tissue is removed. Your decision may be impacted by several factors, including:

• Follow-up radiation therapy: If you choose tissue reconstruction and your care plan involves radiation treatment, you will need to wait until after that treatment is completed. Otherwise, you risk damaging the healthy tissue taken from the donor site. This often is not a factor if you choose implants.
• Type of breast cancer: Some cancers require more extensive removal of skin tissue, making it more challenging to do immediate reconstruction.
• Surgical considerations: Some women prefer to have as much as possible done during the initial mastectomy. But even if you choose immediate reconstruction, there may be the need for follow-up procedures.
• Timing: You may prefer to put off the decision until after you have recovered from the mastectomy. This offers more time to consider your options.