Breast Cancer: Breast Reconstruction After Breast Surgery
What is breast reconstruction?
Breast reconstruction is surgery to create a new breast in place of a breast that
has been removed (mastectomy). A breast mound is created that comes as close as possible
to the shape and look of a natural breast.
The surgery may be done to reconstruct either 1 breast (unilateral) or both breasts
(bilateral). The goal of the surgery is to create a breast mound that matches the
opposite breast. If both breasts have been removed, the goal of the surgery is to
create both breast mounds about the size of the woman’s natural breasts.
Making a decision about breast reconstruction
The decision to have breast reconstruction is a personal one. It depends on how you
think you will feel after a mastectomy. If you think you would feel uncomfortable
with a flat chest or wearing a false breast (prosthesis), you may want to consider
breast reconstruction. If you don’t want to have any more surgeries, you may not want
to do it.
If you’re thinking of having breast reconstruction, talk with your doctor about it
before you have your mastectomy. Your doctor can tell you whether reconstruction is
an option for you. And he or she can tell you what type of reconstructive surgery
might work best for you.
Your doctor will talk with you about factors that can affect whether the surgery will
work for you. These include:
The size and location of the cancer, which determines the amount of skin and tissue
to be removed in the mastectomy
The amount of tissue removed from the breast
If your chest tissue has been damaged by radiation therapy or aging, and is not healthy
enough for reconstruction surgery
Potential for complications
Your overall health and medical history
When is the best time to have breast reconstruction?
Talk with your doctor before your mastectomy. He or she will then talk with you about
your options for:
Immediate reconstruction. This is reconstructive surgery done at the same time as the mastectomy.
Delayed reconstruction. This is a surgery done after recovery from the mastectomy. If radiation therapy is
part of the treatment protocol, the surgeon may advise waiting until after the radiation
Here are some things to keep in mind about the best time to schedule it:
Your emotional and psychological well-being. Some experts think that waking up from a mastectomy with the reconstruction already
done is less traumatic than waking up without a breast.
Any other treatments you are having. If you’re getting radiation after your surgery, you may need to postpone breast reconstruction.
Radiation to the reconstructed breast can increase the chance of problems.
Recovery time. Having reconstruction surgery at the same time as your mastectomy may mean you’ll
The condition of your skin. If your skin isn’t ready for the stretching that goes on during reconstruction, you
may need to have the procedure later on. For example, the skin of women who smoke
or who have diabetes may need extra healing time before reconstruction.
Common risks of breast reconstruction
Any type of surgery has risks. The risks of breast reconstruction include:
Fluid collection in the surgical area
Excessive scar tissue
Problems with the sleep medicines (anesthesia) used during surgery
Bruising and swelling
Problems with the breast implant
The most common complication of breast reconstruction done with implants is capsular
contracture. This is when the scar (capsule) around the implant begins to tighten.
In some cases, a second surgery is needed to fix this problem.
What are the different types of breast reconstruction?
There are 2 main types of reconstruction surgery:
Expander/implant. This is the use of an expander to create a breast mound, which may be followed by
the placement of a filled breast implant.
Autologous tissue. The use of the person’s own body tissues to reconstruct a new breast mound. These
reconstruction surgeries leave you with 2 surgical wounds: the chest and the site
where tissue was removed.
You may also decide to have other procedures to improve how your new breast shape looks.
For example, you might decide to have reconstructive surgery on your other breast
so that it matches your new breast shape. Or you may want to have a nipple reconstructed.
Expanders are empty silicone "envelopes" placed under the pectoralis muscle. This
muscle is between the breast and the chest wall. To enable the skin and soft tissues
of the breast to grow, the expander is filled with saline solution over a period of
several weeks. The saline is injected into the expander through a valve or port in
the expander that lies just under the skin. Once the expander has been completely
filled, it is left in for several more weeks to months. This allows for maximum skin
and soft tissue growth. Once the skin has stretched enough, a second surgery is done
to remove the tissue expander and insert the permanent implant beneath your muscle
Implants are envelopes filled with liquid that are put under the breast tissue and
are used to form the shape of the breast. Implants may be filled with saline or silicone
gel. Each type of implant has advantages and disadvantages. Your doctor will discuss
the types of implants with you and help you decide which type to use.
Autologous tissue surgery
There are different ways to do this surgery, such as:
Transverse rectus abdominous muscle (TRAM) flap. This is the most common method. An area of fat, skin, and muscle is removed from
the belly (abdomen) and moved to the chest. The surgery gives you a tummy tuck. TRAM flaps
may change as you gain and lose weight. It’s important to know that removing stomach
muscle can increase stress on the back. This type of surgery leaves a horizontal scar
across the lower abdomen plus a scar on your chest.
Deep inferior epigastric perforator (DIEP) flap. This is is a method in which the surgeon takes fat and skin but not muscle from your
lower belly and moves them to the chest. This surgery also gives you a tummy tuck.
Gluteal free flap. The surgeon removes part of the skin, muscle, and fat from your buttocks, and grafts
it onto the chest. This is a more complex surgery. It is sometimes done with 2 teams
of surgeons. One team may remove the flap, and the second prepares the blood vessels.
Latissimus dorsi flap. This method moves muscle, fat, blood vessels, and skin from your upper back to your
chest. Sometimes an implant is also needed with this surgery.
Healing after surgery
Immediate reconstruction surgery has a longer recovery time than for mastectomy alone. Recovery
from delayed reconstruction is much quicker. With autologous tissue surgery, there's
a second surgery site that will need to be cared for as it heals.
It's important to know that it can take up to 2 months before the final results of
breast reconstruction can be seen. Be patient as your body heals.