Undergoing a mastectomy can be a disheartening experience. While having cancerous breast tissue removed can be a relief, many women find it devastating to lose their breast completely.
Undergoing a mastectomy can be a disheartening experience. While having cancerous breast tissue removed can be a relief, many women find it devastating to lose their breast completely. But some find hope in the idea of breast reconstruction surgery, which rebuilds the breast and may bring a greater sense of normalcy after a mastectomy. Here’s what to consider.
What is breast reconstruction?
Breast reconstruction is usually only done in cases of mastectomy, where a breast has been entirely removed as part of breast cancer treatment. For women who’ve had a lumpectomy, in which only part of the breast is removed, this procedure usually isn’t necessary, since less drastic procedures are more appropriate. There are several types of breast reconstruction surgeries, including:
Implant procedures: This is when silicone gel or saline-filled implants are placed where breast tissue has been removed. Sometimes if tissue is tight or flat, this is done in two stages: In the first, an expander is inserted to stretch the tissue and several months later, the implant is added. The risks involved with this type of procedure include scar tissue, pain and infection. The implant could rupture or need to be replaced in the future, so you’ll likely have to have them checked periodically post-surgery.
Tissue flap procedure: Instead of implants, it might be possible to use your own tissue—removed from your back, thighs, buttocks or tummy—to rebuild the breast. Remember there will likely scarring where tissue is removed and you could risk muscle damage or weakness, but your own tissue is more likely to behave as your own breasts would—it could get larger or smaller as you gain or lose weight and it won’t rupture or need to be replaced as implants would.
Nipple reconstruction: Some patients just have the shape of their breast recreated. Others choose to include a reconstructed nipple in their plan. Know that nipple reconstruction is a separate procedure completely and usually takes place about three to four months after the breast reconstruction, so the patient has had time to heal. Usually, tissue is taken from another part of the patient’s body to create the nipple, and a tattoo is used to darken the skin to give the appearance of an areola. In some cases, a woman undergoing a mastectomy can ask to have a nipple sparing procedure, in which the nipple is saved and can be used in the reconstruction. This is a rare instance though, since the nipple is likely to hold cancerous cells.
When should I have it done?
When deciding to have breast reconstruction surgery, one of the biggest questions is timing. Some women choose an immediate surgery, which means the procedure is done right after the mastectomy, while the patient is still in the operating room, sedated. This can be a good choice, since there’s no chance of scar tissue having appeared between the procedures, and the patient only has to undergo anesthesia once for both procedures. The other option is delayed surgery, in which the reconstruction is done long after the mastectomy.
Sometimes, the patient doesn’t have a choice and must have a delayed procedure because she needs additional radiation treatment after her mastectomy. It can also be tough to accept a breast cancer diagnosis, and a patient might need extra time after her mastectomy to decide whether or not to have breast reconstruction. Know that breast reconstruction often takes more than one procedure, depending on the details of your particular surgery.
What else should I know before deciding to have breast reconstruction?
Breast reconstruction surgery carries both emotional and physical risks. Going in, you should know that your breasts will never look or feel exactly the same as they did before mastectomy, and you should talk with your doctor about exactly how they’ll look after. Sometimes there’s unavoidable scarring—and if you have a tissue flap procedure, the scarring can be in several places on your body.
Medical risks to the procedure include bleeding, swelling, pain and scar tissue growth. You could also get a post-surgery infection. There’s also the risk of problems with the general anesthesia typically administered in this type of procedure. If any problems with your implants or tissue flap crop up, you could need additional surgery later on. And if you smoke, know that smoking could delay your healing and mean more noticeable scars—for this reason, it’s a good idea to quit smoking a few months before the procedure.
What happens after breast reconstruction?
You’ll be sent home from the hospital anywhere from one to six days after surgery. You’ll likely be sleepy and sore for at least the first week or two and you may have a tube, called a drain, in place to help empty extra fluid from the surgery site.
You’ll probably have to avoid strenuous activity and lifting heavy objects for a month or two. But after six to eight weeks, you’ll likely be as active as you were before the surgery, and at that time, much of the bruising and swelling will have faded. But know that how your breasts looks then aren’t necessarily how they’ll look long-term, since it can take a year or two for the tissue to completely heal and scars to fade as much as they’re going to (which may never be completely).
It may take a while to get used to a new, reconstructed breast. Counseling and talking with other women who’ve undergone mastectomy and breast reconstruction procedures can help. The happy news is that breast reconstruction can’t cause cancer to return. You’ll want to talk to your doctor about what follow-up and care is needed after your surgery, so you can have the best possible results and heal—both physically and mentally—as easily as possible.