Your Guide to Breast Reconstruction after Mastectomy for Breast Cancer

by Dr Amit Jotwani

Women who have undergone surgery as a part of their breast cancer treatment may consider breast reconstruction surgery to rebuild and restore the shape of their breast. 

Breast reconstruction involves rebuilding the shape and look of the breast through various methods. 

Breast reconstruction surgery can be performed either at the time of mastectomy, which is known as immediate reconstruction, or it can be performed after completion of breast cancer treatment. This is known as delayed breast reconstruction. 

after breast cancer surgery

The time period for delayed reconstruction may range from months to years.

Breast reconstruction can leave scars which gradually fade away over time. However, latest innovations over the past decade have minimized scarring and significantly improved appearance. 

Several options are available for women who choose to get their breast rebuilt. It is important to consult your team of surgeons and oncologists before making a decision about breast reconstruction surgery. 

Every patient’s condition may be different and your team of doctors will assist you with the best options based on your situation.

Eligibility criteria for breast reconstruction 

Although, most of the breast cancer survivors are potential candidates for breast reconstruction, the eligibility depends on various factors.

  • Timing and decision making

Mastectomy is generally not an emergency surgical procedure. Therefore, it is important to take enough time to gather all the information you need about your condition and breast reconstruction. 

Do your research, take multiple opinions, and talk to your doctors about the timing of breast reconstruction. 

Focus on decisions which help your short and long term recovery outcomes. Once you get a clarity on all aspects of breast reconstruction, you may go ahead with the procedure as guided by your doctors.

  • Stage of breast cancer

Women diagnosed with early stage breast cancers (stage I and II) are mostly not indicated for radiation or other related treatments following mastectomy. These women are often good candidates for immediate reconstruction, where mastectomy and reconstruction is carried out as a single procedure. 

However, if radiation is indicated, your surgeon will guide you with appropriate timing for your reconstruction. 

Women diagnosed with late stage cancers (stage III and IV) are always indicated for radiation therapy following mastectomy. In these cases, doctors advise to delay reconstruction as radiation and chemotherapy may interfere with reconstruction outcomes. 

Additionally, reconstruction requires more time to heal and this could delay radiation and chemotherapy. 

  • General health condition 

Women with existing chronic conditions such as diabetes, heart diseases, bleeding disorders, etc. may not be good candidates for breast reconstruction surgery. These women may have to wait until they have fully recovered from the mastectomy. 

Your doctor will guide you based on your condition after completing your recovery from mastectomy.

Women who are heavy smokers would be advised to quit for a certain period of time before breast reconstruction surgery, as smoking interferes with the healing ability of the body.

  • Body Mass Index (BMI)

Patients with a BMI > 40 are not recommended for breast reconstruction due to the risk of failure. These patients may be potential candidates for delayed reconstruction after being reviewed by a multidisciplinary team consisting of a breast surgeon, a plastic surgeon, a dietician and a psychologist. 

Types of breast reconstruction 

Several types of breast reconstructions are available and it is recommended to discuss with your doctors about the best suitable type for you based on your health condition and personal preferences. Below are the different types of breast reconstruction: 

  • Breast reconstruction using implants

Most mastectomy procedures are performed using a technique called skin sparing mastectomy, where the majority of breast skin is preserved for reconstruction. 

Implants are placed beneath the skin or muscle. There are several different types, shapes and sizes of breast implants which are made up of an outer flexible silicone shell. 

The inner portion may contain saline or silicone gel. Saline implants are filled with sterile water. 

Silicone gel-filled implants provide a more natural sensation of breast tissue. These are more stable and firm, and less likely to break. 

silicon implants

Silicone implants

Breast implants may be placed during mastectomy or can be started during surgery and completed at a later point after the procedure.

  • Breast reconstruction using flaps

This type of breast reconstruction is performed through a procedure known as autologous tissue reconstruction. 

The procedure involves usage of tissue from other parts of a woman’s body to rebuild the breast. This piece of tissue is known as a flap. The tissue flaps may be taken from different sites of the body including the abdomen, back, thighs or buttocks.

Tissue flaps act as more natural breast tissues as they contain the body’s natural skin, blood vessels and fat. Sometimes, breast implants and tissue flaps are used together in cases where there is inadequate skin and muscle for placement of breast implants after mastectomy.

  • Reconstruction of nipple and areola 

Nipple and areola reconstruction is a separate procedure that is carried out as the final phase of breast reconstruction. It is performed after the breast has healed from the reconstruction surgery, which usually takes about 3-4 months. 

Generally, the nipple is rebuilt using tissue extracted from the reconstructed breast or rarely from other sites of the body. The areola is then created after a few months, using tattoo ink.

In some cases, the areola may be created using skin grafts from the groin or abdomen. Some women may only prefer getting a 3-D nipple tattoo without reconstruction. A skilled tattoo artist or a plastic surgeon may use different pigmented shades to give the tattoo a three dimensional look.

Questions to ask your doctor before deciding on breast reconstruction 

Here are some questions you may ask your breast surgeon and plastic surgeon before you make your decision on breast reconstruction: 

  • Am I a good candidate for breast reconstruction?
  • What are the associated risks and complications of breast reconstruction?
  • What are the reasonable expectations I can have from breast reconstruction?
  • What are my different options for breast reconstruction?
  • How long does it take to recover from a breast reconstruction surgery?
  • Will I be able to function comfortably after breast reconstruction surgery?
  • What type of breast reconstruction would be most suitable for me?
  • Can I see pictures of successful breast reconstruction (before and after)? 
  • What is the average cost of breast reconstruction?
  • How will my breasts feel after reconstruction?
  • How would you decide if I need immediate reconstruction or delayed reconstruction?
  • What kind of changes can be observed with breast reconstruction over time?
  • Will breast reconstruction interfere with radiotherapy and chemotherapy?
  • What are the options for nipple reconstruction?
  • Is there any special care I would need to take for my reconstructed breast?

You can read about what to wear after breast cancer surgery here

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