Breast Reconstruction

If you are planning to have surgery to remove a breast, called a mastectomy, talk to your surgeon about reconstruction before you have the mastectomy. Your mastectomy might need to be done in a certain way for you to be able to have the type of reconstruction you want.

Do I need breast reconstruction after mastectomy?

No, you do not need it. The decision to have reconstruction is totally up to you. Some women do not mind having only 1 breast. Other women feel better about themselves or feel like they look more normal if they have reconstruction after mastectomy. Having reconstruction also helps with posture and the way clothes fit. The important thing is that you have a choice about what to do.

What if I decide not to have reconstruction?

If you decide not to have reconstruction, the side of your chest that had surgery will be flat and have a scar on it. If you want, you can wear a special bra with a pocket for a soft plastic breast. That way you’ll look more even, and your clothes will probably fit better.

When can I have my breast reconstructed?

Breast reconstruction can be done at the time of mastectomy or later. The timing for you will depend on the stage of your cancer and what other treatments you need. Also, if you want to delay reconstruction for personal reasons, you can ask your doctor about doing that.

Women with early-stage cancer or who are having mastectomies to prevent cancer can have the reconstruction at the same time as their mastectomy. This is called “immediate reconstruction.” The skin that is left after a mastectomy can be used like a pocket to hold the tissue that will make up the new breast.

Women with a later-stage or large cancer sometimes need to have radiation after mastectomy. (Radiation is a treatment that kills cancer cells.) These women sometimes need to delay reconstruction until the radiation treatment is finished. This is one type of “delayed reconstruction”. The delay is needed because the reconstructed breast could keep the radiation from reaching the right areas. Plus, radiation could potentially damage the reconstructed breast.

What are the different ways that surgeons can reconstruct a breast?

The two main ways are with implants or with flaps. Plus, there are several kinds of flaps, each named for the muscles they are made of. The best reconstruction approach for you will depend on:

• How big your breasts are to begin with.
• How much extra body fat you have and where.
• Whether you smoke, are overweight, or have health problems, such as diabetes, or heart or lung disease.
• Whether you have had surgery before and on what part of your body, because scars might affect which tissue can be used.

How does reconstruction with an implant work?

A breast implant is basically a breast-shaped container that is filled with salt-water (called “saline”) or something that feels like Jell-O (called “silicone”). The implant is inserted under a layer of muscle in the chest or under the skin, depending on your surgeon’s preference.

Getting an implant can be either one or two steps, depending on the skin flap at the time of mastectomy. In the two stage procedure, the surgeon inserts a device called an “expander.” This device stretches the skin and muscle in the chest, so that they can hold the implant later. Doctors gradually add more and more fluid to the expander until the skin and muscle are stretched enough for the implant. Then, the surgeon does another surgery to insert the implant. Implants are best for women with smaller breasts that don’t droop.

How does reconstruction with a flap work?

That depends on which type of flap is used. The most commonly used flaps are:

• DIEP flap – A DIEP flap is taken from the belly,  it is made up of skin and fat but NOT muscle. Connecting these flaps to a good blood supply requires microsurgery.  That means the surgery can be more complicated and take longer. This is done with experienced plastic reconstructive surgeons.

 

• TRAM flaps – A TRAM flap is similar to DIEP flap and is made up of skin, fat, and muscle. When the muscle in the flap stays attached to the blood vessels that supply it, it is called a “pedicled TRAM flap”. This type of flap is tunnelled under the skin from the belly to the new breast pocket.

 

• When the flap is completely disconnected from the belly and its blood vessels, it is called a “free TRAM flap”. This type of flap is attached to a new set of blood vessels in the chest. It doesn’t stay connected, so it does not have to be tunnelled to its new location.

 

• Both kinds of TRAM flaps can be done only in women who have enough belly fat to make a flap. After surgery, the belly looks flatter, like it does after a “tummy tuck”. Women who have this type of flap have a scar along their bikini line from hip to hip.

 

• Lat dorsi flap – A Lat flap is taken from the back and is made up of skin, fat, and muscle. The flap stays attached to its own blood supply and is tunnelled under the skin from the back to the chest. Women who have this kind of flap have a scar on their back beneath the bra line. They also often also get an implant, because there is not enough fat on the back to make a new breast.

 

• Flaps taken from other places – Women who do not have enough belly fat to make good TRAM or DIEP flaps can have flaps taken from other parts of their body. For instance, doctors sometimes take flaps from the rear end or inner thigh.

Will my nipple be reconstructed?

If you want it to be, yes. Nipple reconstruction is usually done a few months after the breast construction is done. To make a new nipple, the surgeon can rearrange the tissue that is already there or use tissue from another part of the body. Surgeons also sometimes tattoo the nipple and the area around the nipple to make it the right colour.

Will my new breast match my other breast?

As much as possible, yes. But the new breast will never be like the one you had before or like the other breast. Plus, you won’t have normal feeling (sensation) in the new breast. Your surgeon might need to operate on your healthy breast to make the two breasts look as similar as possible.

Can I choose which kind of reconstruction to have?

Yes and no. Only some of the reconstruction types will be appropriate for you. But if you think you would rather have one type of reconstruction over another, ask your surgeon if that approach would work for you. He or she can tell you if your choice makes sense, and if not, why not?