Breast Reconstruction After Mastectomy

There are measures you can take to make your mammogram more comfortable.

Receiving a breast cancer diagnosis is devastating enough, but being told that your breast will have to be removed can really throw you into emotional turmoil: How do you deal with losing an essential part of what physically makes you a woman? Will you ever look normal again?

After surgery to remove one or both breasts—a procedure known as a mastectomy or double mastectomy if both breasts are removed—patients face several options. Some women accept their new appearance as a testament to their cancer battle. Some wear an artificial breast, or prosthesis. Others opt for breast reconstruction, which can allow your breasts to appear normal under clothing and can give you a much-needed confidence boost.

Breast reconstruction surgically restores the breast’s shape, and a reconstructive plastic surgeon may be able to perform the procedure at the same time as your mastectomy. Women who’ve had a disfiguring lumpectomy, or removal of just the cancerous area, can also benefit from breast reconstruction.

Whether you’re a candidate for reconstruction is something you have to discuss with your oncologist. If you are, he or she can recommend a plastic surgeon experienced in this type of procedure.

Types of Reconstruction

Reconstruction may involve an implant or a "flap" procedure, each with or without nipple reconstruction. Your options depend in part on your preference, age, weight, smoking habits and the type of cancer treatment you receive—all factors you should discuss with your healthcare provider, who can also advise of the risks associated with each procedure:

  • Breast implants look like teardrop-shaped pouches filled with saltwater or silicone gel. The surgeon inserts an implant into a pocket he or she creates behind the muscle in your chest. The surgeon may need to temporarily place a balloon-like expander under your chest muscle to gradually stretch the tissue first, which can take several months, before inserting the implant more permanently. Possible drawbacks include infection, a displeasing appearance and implant rupturing. Also, an implant isn’t a device that will last a lifetime, so you’ll probably need surgery in the future to remove or replace it.
  • Flap surgery is more complex than inserting an implant but often produces the best results because the flap, made from human tissue, has a more natural look and feel. A common type of flap surgery is the TRAM (transverse rectus abdominis muscle) procedure in which tissue—including fat, muscle and blood vessels—is taken from the tummy area and tucked into a pocket created in the chest. Tissue can also be taken from other areas such as your back or buttocks. Because a flap procedure involves blood vessels, it’s usually not offered to women who smoke or who have diabetes, vascular disease or connective tissue disorders such as lupus and rheumatoid arthritis. Complications include wounds that don’t heal well, hernia, fluid buildup, infection and tissue death from an insufficient blood supply. It also takes longer for the breast to completely heal—in some cases one or two years.
  • Nipple and areola reconstruction (NAR) is a possibility once the new breast has fully healed. In this procedure, the surgeon rebuilds the nipple by transferring breast tissue or skin from another part of the body onto the new breast, then tattoos it to match your natural nipple and areola—the darker area surrounding the nipple. Saving the original nipple isn’t recommended since it may contain cancerous cells.

Be Realistic

It’s important to remember that while breast reconstruction can restore your breast’s contour, you shouldn’t expect your breast to look or feel the same as it did before the operation. While the scars may fade a bit over time, the new breast may continue to feel hard or lumpy and may not match your other breast (though even natural breasts are rarely completely symmetrical). Nor will you feel normal breast or nipple sensation.

To help you choose an option, ask your healthcare provider to connect you with the American Cancer Society’s Reach to Recovery program, a network of trained volunteers who’ve gone through breast reconstruction. You should also contact your insurance company to see what your insurance plan covers. Armed with the facts, you’ll be able to make the best decision for your physical and emotional health.

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