If you’ve had a mastectomy because of breast cancer, you may choose to have reconstructive plastic surgery. It can restore balance between the two breasts by replacing skin, breast tissue, and the removed nipple.
The amount of reconstruction will depend on the mastectomy and the width, size, and location of the removed tumor.
Is Breast Reconstruction Right for Me?
The idea of living without a breast or without part of one affects each woman differently. It’s a personal decision, and it's often not easy to make.
You don’t have to have reconstruction. You can wear external breast forms or pads, or change nothing at all.
Plastic surgery now gives better results than ever before. You can have breast reconstruction using breast implants or your own tissue.
The operation changes your appearance, but it can have psychological benefits as well. It can add to a sense of wellness for you and your family.
Is It Cosmetic Surgery?
Restoring a breast isn’t considered a cosmetic procedure. It’s reconstructive surgery. Since it’s considered part of the treatment of a disease, the law says insurance providers must provide coverage.
When’s the Best Time to Have Breast Reconstruction?
The timing is based on what you want to do, your medical conditions, and your cancer treatment. You can have it done during the operation to remove the breast, or you can have it months or years after a mastectomy.
If you've started chemotherapy or radiation treatments, reconstruction is usually put off until they’re finished. Your surgeon can help you decide the best timing for you.
What Are the Different Reconstruction Options?
Before you decide, you and your doctor will need to discuss your wants and needs, your medical condition, and any previous surgery.
Implants involve stretching the skin with a tissue expander that goes inside your body and then inserting a silicone gel or saline (saltwater) implant weeks later. The tissue expander is filled to a certain volume by adding saline, usually once a week for a few sessions. You may have some pain, but many women are pleased with the final result.
Implants can rupture, causing pain and infection. You may need surgery to remove or replace them.
TRAM flap procedures use the tissue from your belly area to create a mound to reconstruct the breast. In general, this means cutting away at least some of your stomach muscles, fat, and blood supply to use for the reconstruction.
Sometimes, the tissue that’s being moved is kept attached to its blood supply. This is called a pedicle or tunneling procedure. The flap has a better chance of surviving because the blood supply remains in place, but the breast may not look exactly the way you want.
In a free-flap procedure, the tissue is disconnected and then attached to a blood supply near the new location. This is a more complicated procedure. The biggest risk is that the blood vessels may get clogged and the flap might die. The benefit is that the reconstruction looks more like a natural breast.
A new version of the procedure, called the muscle-sparing free TRAM flap, cuts away far less muscle from the belly area. This often makes for a quicker recovery and less risk of losing core strength after surgery.
For all TRAM surgeries, you can expect a scar across your belly from one hip to the other, typically below the bikini line. You might also notice a flatter and tighter stomach because of the missing fat, skin, and muscle. Your health care provider will give you detailed instructions on how best to care for your surgical wounds after surgery. It should take six to eight weeks to fully recover from your surgery.
Though it’s the most common flap procedure, TRAM flap isn't for everyone. It may not be for you if you:
- Have had numerous prior surgeries in the belly area
- Are especially thin or don’t have enough extra belly tissue
- Are concerned about losing core strength, especially in your lower belly area
Also, talk to your doctor if you plan to become pregnant, as the TRAM surgeries could be a problem in some cases.
Other, less common tissue flap procedures use tissue from different areas. Taking tissue from the back is called a latissimus dorsi flap.
Another form of flap more commonly performed, called the DIEP-free flap, uses fat and skin from a similar area of the belly area as a TRAM flap. No muscle is taken from the wall of the belly area with this procedure.
Aesthetic flat closure (AFS) may be considered. This is repair surgery that removes or rearranges excess breast skin and fat after a mastectomy. This corrects contour defects and can be done at the time of a mastectomy or as a second procedure. If needed, fat grafting can also be done for the best cosmetic outcome.
You may want to think about nipple reconstruction, too. Usually, the nipple and areola (the dark area around the nipple) are removed during the mastectomy to lower the chance of cancer returning.
Nipple reconstruction is typically an outpatient procedure done with local anesthesia. You may have it after breast reconstruction. This allows the new tissue to heal and settle into place. Your doctor can make small changes in the size and position of the breast when the nipple and areola are rebuilt.
Surgeons can often make a nipple out of skin taken from the breast where the new nipple will be. The areola is sometimes made from skin from another part of the body. The nipple and areola can then be tattooed to resemble the color of a nipple.
In rare cases, the nipple from the original breast can be reattached, but only if the surgeon is convinced that the tissue is cancer-free. Because of a lack of nerve connections, the nipple won’t rise or flatten in response to touch or temperature.
A prosthetic nipple is another option. The plastic surgeon makes a copy of your natural nipple and colors the areola. It can be glued to the breast and re-glued every week or so.
How Long Does Breast Reconstruction Surgery Take?
Preparation for the procedure, including anesthesia, may take two hours. The reconstruction will take one to six hours.
After the surgery, you'll spend about two to three hours in recovery before being transferred to a hospital room.
Recovery From Breast Reconstruction Surgery
You may have some discomfort for the first few days afterward. You’ll get pain medication as needed. Throughout your hospital stay, the staff will closely watch you.
Soon after surgery, you’ll be encouraged to move your arms, but not for any forceful activity like pulling yourself up, getting out of bed, or lifting heavy objects. Nurses will help you in and out of bed. The day after surgery, you may be able to sit in a chair beside the bed. On the second day, most patients are walking without help.
You’ll probably get IV fluids for a day or two. You may have a urinary catheter overnight or until you can walk to the bathroom. And where the surgeon made cuts (the incision sites), you’ll have drains. If you go home with these drains in place, you’ll get instructions on how to care for them.
The length of your hospital stay depends on the type of operation and how your recovery goes. If you got implants, the average hospital stay is one to two days. Flap procedures may require a stay of five to six days.
What Are the Possible Side Effects of Breast Reconstruction Surgery?
Flap tissue death (necrosis). Rarely, you may have blood flow problems during the first few days after flap reconstruction. Tell your doctor right away if your breast turns blue or black, feels cool, or develops an open sore. They may be able to save the tissue with another surgery.
Capsular contracture. Your immune system naturally walls off foreign objects from the rest of your body. In some cases, this scar tissue can harden and squeeze an implant. This might hurt or change the placement and look of your breast. You may need treatment to remove the scar tissue or implant.
Dangers for smokers. Your blood vessels tighten when you use tobacco products. A lack of blood flow reduces the nutrients and oxygen your tissue needs to survive and heal quickly. You may need to delay reconstruction until you quit smoking for a few weeks or months. Ask your doctor for help if you can’t stop on your own.
Breast implant-related cancer. Breast implants raise your odds of a rare type of immune system cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). If you have implants, your chance of getting ALCL is very low. Discuss this risk with your doctor.
You may also have:
- Serious tiredness after surgery
- A sick feeling or other anesthesia problems
- Problems with the implant later on, like ruptures or dents
- Arm or shoulder problems on the same side as your reconstructed breast
- To get more surgeries to fix reconstruction problems
- Uneven breasts
Reconstruction and Breast Cancer Recurrence
There's always a chance that breast cancer can come back after treatment. But breast reconstruction doesn't make this more likely to happen. And if the cancer does return, reconstruction won't make the tumor harder to find or treat.
Breast Reconstruction After Mastectomy in Men
Less than 1% of all breast cancers in the U.S. happen in those assigned male at birth. But a growing number of men choose to have some type of breast reconstruction after a mastectomy.
After surgery to remove your breast cancer, a plastic surgeon can rebuild the shape of your chest and nipple. This typically takes place after you heal from your mastectomy and finish any other breast cancer treatments.
Breast reconstruction in men may include:
Fat grafting. The plastic surgeon can take fat from your thighs, belly, or bottom and use it to rebuild your chest tissue. They’ll use a small needle to inject this fat tissue into your chest.
This procedure can:
- Re-create the mound in your chest
- Soften the look of skin after radiation
- Add volume after another type of reconstruction
Flap tissue reconstruction. Most often, flap surgery for men involves taking tissue from the upper back to re-create the chest (latissimus dorsi flap). But your plastic surgeon may take fat, skin, or blood vessels from your lower belly or other areas.
Breast implant reconstruction. You’ll usually get a solid implant put under your chest muscle. But sometimes, surgeons use small soft implants, like the kind used most often for women, in men.
Nipple reconstruction or nipple tattoos. Just like in women, a plastic surgeon can re-create the look and shape of your nipples and areolas with surgery or tattoos.
Scar revision. You can have surgery to improve the look and feel of your scars.
Follow-Up Care for Breast Reconstruction
After you go home, you can expect some soreness, swelling, and bruising for two to three weeks. You may be told to put medications on the suture area or change bandages at home. Your plastic surgeon will advise you about showering, bathing, and wound care.
Most women return to regular activities within six to eight weeks after surgery. It may be several weeks before you can do strenuous exercise.
The mastectomy and breast reconstruction will leave areas of numbness where the surgery was done. Instead of pain where the tissue was taken, you may feel numbness and tightness. In time, some feeling may return to your breasts. Most scars will fade over time.
The shape of your reconstructed breast will slowly improve.
You'll need regular checkups at first. If you have a temporary expander, it will be expanded with saline once a week, on average, until the desired size is reached (usually within six to 10 office visits).
Keep doing self-exams of your breasts every month and have an annual mammogram.
Breast reconstruction doesn’t change the chance of cancer coming back, and it generally doesn’t interfere with treatment. If the disease does come back, your medical team can still treat you with surgery, radiation, chemotherapy, targeted therapy, and immunotherapy.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Breastcancer.org: “Necrosis of the Tissue Flap,” “Capsular Contracture,” “Male Breast Cancer,” “Treatment of Male Breast Cancer,” “Screening After Breast Reconstruction,” “TRAM Flap,” ”TRAM Flap Reconstruction: What to Expect,” “Nipple Reconstruction Surgery and Nipple Tattoos.”
American Cancer Society: “Types of breast reconstruction,” ''Breast Reconstruction After Mastectomy,'' “What to Expect After Breast Reconstruction Surgery,” “Reconstructing the Nipple and Areola After Breast Surgery,” "Should I Get Breast Reconstruction Surgery?"
Mayo Clinic: “Is there any connection between breast implants and cancer? And if so, how serious is the risk?”
Facing Our Risk of Cancer Empowered (FORCE): “Personal Story: Juliet’s story: No reconstruction is a post-mastectomy option.”
American Society for Plastic and Reconstructive Surgeons: “Breast Reconstruction.”
Cancer Research UK: “Breast reconstruction using body tissue.”
