Whether you’ll receive breast reconstruction after breast cancer surgery is ultimately up to you. Tissue flap procedures, implants, and reconstruction with your body’s tissues are just a few options.
You may be considering whether to undergo reconstruction after your breast cancer treatment.
Not everyone chooses breast reshaping following surgery, but having reliable information about the possibilities is important.
Your options to restore the shape of your breasts after breast cancer treatment may depend on:
- if the entire breast was removed
- the shape of your breasts
- whether your treatment plan includes radiation therapy
- other health factors that could complicate healing
Implants
A common reconstructive procedure uses
Tissue expanders are a type of temporary implant best for people who have had a mastectomy and want breast reconstruction but can’t or don’t want it done right away.
Permanent implant shells can be filled with a saline solution (sterile salt water) or silicone gel. Some doctors typically use silicone implants because they look and feel more natural than saline.
Newer implants often use form-stable or cohesive gels, which are designed to hold their shape if the outer shell of the implant ever tears or breaks open.
As with many medical procedures, implants can carry some risks:
- Infection and bleeding: both are risks of any surgery, and an infected implant may need to be removed temporarily
- Capsular contracture: occurs when scar tissue tightens around the implant, changing its position. If you experience a contracture, you might need additional procedures to correct this condition.
With a tissue expander or implant, it’s common to spend 1 to 2 nights in the hospital.
Breast implants aren’t considered lifelong prosthetics. Over time, they can degrade or rupture, which means you might need additional surgery to remove or replace them.
If you’re thinking about implants, talk with a reconstructive plastic surgeon or breast surgical oncologist about the implant that may be safest for you.
Tissue flap procedures
Sometimes, it’s possible to rebuild your breast using tissue from other body parts.
These procedures are known as
Types of tissue flap procedures include:
| Flap procedure | Tissue used |
|---|---|
| transverse rectus abdominis muscle (TRAM) flap | abdomen |
| deep inferior epigastric perforator (DIEP) flap | abdomen |
| latissimus dorsi flap | upper back |
| gluteal artery perforator (GAP) flaps | buttocks |
| transverse upper gracilis (TUG) flaps | inner thigh |
One potential downside of flap procedures is that tissue from your body can increase or decrease in size as you gain or lose weight.
Another concern is that tissue flap procedures can
Because flap surgery is more invasive, you can remain in the hospital for 2 to 3 days to ensure the tissue heals well.
If your procedure involves removing muscle from a donor site, it’ll likely change how your body functions in the donor area.
- infection
- blood clots
- hernia at the donor site
- blood supply to the transplanted tissue can be damaged, causing the tissue to die
Nipple reconstruction
In many cases, surgeons can rebuild your nipple and areola for a more natural appearance after reconstruction. The areola and nipple can be tattooed to match your natural coloring.
While the appearance of the nipple can be improved, you may not have sensation in the area, and you may need touch-up tattoos if they fade over time.
Oncoplastic reconstruction
Oncoplastic reconstruction is when the breast surgeon has to remove a larger lumpectomy. An oncoplastic reduction is then often recommended to help reconstruct the breast.
This can help camouflage the effects of the lumpectomy surgery.
Most often, these procedures involve a breast lift or reduction.
Some people opt for immediate reconstruction, while others delay it until treatment completion.
Immediate reconstruction
With immediate reconstruction, a plastic surgeon may place an implant under the skin or muscle tissue as soon as the oncological surgeon has removed the breast tissue.
It’s also possible that your surgeon could place an expander to gradually stretch tissues enough to place an implant a few weeks later.
In some cases, tissue flap surgery can be performed on the same day as the mastectomy.
Delayed reconstruction
Some people delay breast reconstruction for a week, months, or years after treatment because:
- their treatment plan includes radiation therapy, which can further change tissue in the area and can damage implants
- they experience anxiety or distress about the results of a mastectomy
- at the time of surgery, they were undecided about whether to have reconstructive procedures
- their overall health or the stage of breast cancer made it necessary to wait
In the first few days after reconstruction, the areas where you had surgery will be very tender. Your doctor will prescribe medication to manage the pain.
At first, you’ll have tubes extending from the surgical sites. These tubes allow fluid to drain from wounds as you’re healing.
Because the tubes may still be in place when you leave the hospital, a healthcare professional will teach you how to empty and keep them clean.
Many people can begin to feel better within a
Bruising, swelling, and tenderness may continue at least that long — or even longer.
People respond differently to breast surgery and reconstruction. What you experience during recovery will be influenced by:
- the type of surgery and reconstruction you have
- how closely you follow the postsurgical recovery procedures
- your pain tolerance
- whether you smoke
- your mental and physical health before and after surgery
The
Some exceptions exist for religious or government plans. If you are insured under a plan provided by one of these organizations, you’ll need to verify coverage with your insurer.
Medicare and Medicaid
Medicare pays for reconstruction if you’ve had a mastectomy to treat breast cancer.
Medicaid coverage varies from state to state, so you’ll need to check with your state Medicaid office to determine what reconstruction benefits are available where you live.
Deciding whether to reconstruct your breasts is a personal choice. It’s OK to have a lot of questions and to feel confused and emotional during the process.
Some questions you might want to consider include:
- Which procedure will leave me feeling the most like “myself”?
- How will these procedures affect my ability to do the activities that are important to me?
- How much support and assistance will I need during recovery?
- How much time will I need to take off work with each procedure?
- Am I emotionally ready to make this decision right now?
You are not alone in having these questions. Discuss your concerns and questions with your doctors so you have the information and perspective you need to decide.
If you have experienced sexual assault or childhood sexual abuse, breast cancer treatment may be extra complicated for you.
It’s OK to talk with a therapist or your cancer care team about the feelings you’re experiencing. It’s also OK not to disclose the experience if it feels uncomfortable.
Journaling, talking with a friend, or being extra gentle with yourself can all help you process your experience.
It may also benefit you to talk with people who share your experience. You may want to try:
American Cancer Society (ACS) - Healthline’s Bezzy Breast Cancer
- Young Survival Coalition
- Cancer Financial Assistance Coalition
- American Society of Plastic Surgery
Breasts can be reconstructed using implants, your own body tissues, or reshaping procedures. Breast reconstruction can be done at the same time as a mastectomy or lumpectomy, or it can be done weeks, months, or years later.
Reconstructed breasts will usually look and feel different than they did before.
The procedure that’s best for you will depend on your diagnosis, your breast size and shape, your overall health, and whether you may need chemotherapy or radiation.
It’s OK to ask questions, consider your priorities and desires, and make a decision that feels right for you for now.