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Breast Reconstruction After Mastectomy

Understanding the Benefits and Risks

While it may be a necessary part of breast cancer treatment for some, a mastectomy can leave a woman with new challenges as she struggles to come to terms with the physical and emotional impact of having breast tissue removed. That’s why some women may choose to undergo breast reconstruction surgery to rebuild the shape, size or symmetry of their breast(s). Although it does not restore breast health, reconstruction can provide more natural-looking breasts and may help restore confidence that can be lost after a mastectomy.

As with any procedure, there are potential risks, including the need for additional surgery. It’s important to understand your options in order to make the right decision for you.

Breast Reconstruction After a Mastectomy

Although a breast reconstruction can be done at any time after a mastectomy (known as a delayed breast reconstruction), some choose to do both procedures at the same time (immediate reconstruction).

Northwestern Medicine Plastic Surgeon Michael A. Howard, MD, is among those who performs immediate breast reconstruction surgery at Northwestern Medicine Lake Forest Hospital. “This allows patients to recover from both procedures at the same time and potentially reduce the number of surgeries needed in the reconstruction process,” he says.

However, not everyone is a good candidate for immediate reconstruction. “For instance, we may suggest a delayed breast reconstruction if you are going to have radiation treatment, as it may alter the healing,” says Dr. Howard. You may also choose to delay the procedure due to other health issues or personal preference.

Types of Breast Reconstructive Surgery

Once you decide if and when to have breast reconstruction surgery, there are two types to choose from.

Prosthetic reconstruction. “During prosthetic reconstruction, we insert silicone or saline implants in front of the pectoralis muscle to shape the breast,” says Dr. Howard. This procedure can take two or three hours, typically causes less scarring and has a shorter recovery time. However, Dr. Howard cautions, this type of procedure is not without its risks of complication, including rejection of the implant. There is a possibility that an implant will need to be replaced in the future.

Tissue flap (autologous tissue) reconstruction. A tissue flap reconstruction uses tissue from your abdomen, buttocks, back or thighs to rebuild your breast and help it feel more natural. This procedure can take between four and five hours per breast. Because of the multiple incision sites, you can expect more scarring. This type of procedure does entail a longer recovery and includes a hospital stay approximately two days after your surgery to ensure that blood supply is being circulated into the new tissue, says Dr. Howard.

Factors to Consider

“Undergoing breast reconstruction surgery is a very personal decision,” says Dr. Howard. “We are here to support you and provide the information you need to make your decision.”

There are a number of factors that should be taken into consideration when choosing which option is best:

  • The type of mastectomy. These include total mastectomy, partial mastectomy and nipple-sparing mastectomy. The type is determined by the location and size of your tumor.
  • What cancer treatments you’ve undergone. Healing can be affected by your treatment. For example, if you’ve had radiation treatments in the past, your body may be more likely to reject implants from prosthetic reconstruction. 
  • Your body type. Women with larger breasts may request volume reduction in order to create symmetry. Meanwhile, slimmer women may not have enough tissue for a large breast volume following tissue flap reconstruction.

A woman’s breasts are closely linked with feelings of femininity and sexuality, and many women struggle with their body image and self-esteem after breast cancer diagnosis and treatment. In addition to removing the breast tissue, surgery can cause scarring and a loss of feeling in your breast. However, research shows that women who have had breast reconstruction surgery tend to have less anxiety and depression, and are more likely to report feeling sexually attractive than those who have had a mastectomy with no reconstruction.

“It’s rewarding to be able to work with patients and give them back a sense of confidence,” says Dr. Howard.

Northwestern Medicine Breast Cancer Care