Breast Reconstruction Options After Mastectomy

By Kathy Steligo: Author, The Breast Reconstruction Guidebook

The fight against breast cancer has achieved notable progress in the past few years. Health professionals are finding more early-stage tumors, refining and personalizing treatment, and saving more lives. But for many of us, the cure (or efforts to reduce high risk before a diagnosis) includes the loss of one or both breasts.

From a technical perspective, mastectomy isn’t a difficult procedure, but that can be small comfort as you struggle to comprehend and accept the loss of your breasts. The emotional struggle is often more difficult. Whether you’re facing mastectomy to treat or prevent breast cancer, you’re undoubtedly wondering what your body and life will be like after such a significant part of you is lost. You’re probably feeling fear, anger, confusion, remorse, anxiety—some or all of these understandable emotions. Many women say that reconstruction—replacing removed breast tissue with implants, a woman’s own fat (a tissue flap), or a combination of both—helps to make mastectomy more acceptable.  

Some women aren’t compelled to replace their breasts, but for those who wish to restore their physical profile, options are far more plentiful and much more sophisticated than what was available to our mothers and grandmothers. Surgeons have developed many reconstructive advances in the past few years, and results, including new nipple and areola, can be remarkable.

Modern breast reconstruction can be surprisingly good, but it remains imperfect. Results depend on many factors, including a surgeon’s skill and experience. Nor can reconstruction restore breast sensation or the ability to breastfeed after breast tissue is removed, but it can restore your physical symmetry and sense of wholeness. You can wear the same clothing that you wore before mastectomy, without special bras or prostheses. Your new breasts can look natural whether you’re clothed or not. (Any surgery carries certain risk, such as infection, delayed healing, and other issues, and reconstruction is no different.)

You may decide to have your breasts rebuilt using implants, because that’s the shortest beginning-to-end reconstructive procedure, and you don’t want to undergo longer surgery and recovery involved with tissue flaps. On the other hand, if you want to have the most natural-feeling breasts and not worry about replacing implants at some point in the future (or worry about the risk of infection, rupture, or other issues inherent with implants), and you have excess fat in your abdomen, hips, or buttocks, a tissue flap might be the right type of reconstruction for you.

Not all plastic surgeons perform all procedures, and not all women are candidates for every alternative. Some procedures require more (or different) surgical skill; some require more surgery or recovery time than others.

Whether or not to have your breasts recreated is an intensely personal choice. You may consider the decision to be no-brainer. Or you might be conflicted, unaware or confused by what can or cannot be done. In any case, it pays to thoroughly research your options and know what to expect before you decide which plastic surgeon and reconstructive alternative, if any, are right for you. I know this first-hand: after several lumpectomies, two bouts with breast cancer, radiation, and five years on tamoxifen, I ultimately lost both breasts. I then had reconstruction with implants, and subsequent reconstruction with my own tissue.

Learn all you can about mastectomy: the different ways it can be accomplished, what to expect, and how it affects reconstruction. Understand your reconstruction options, including what they provide and what they require. Be your own best advocate and make your own informed decisions.