After Breast Cancer: Understanding Your Reconstructive Choices

If you have been diagnosed with breast cancer, it’s easy to feel overwhelmed by your choices and the potential impact on your life.

In some instances, your options may be limited by the type, size or location of the tumor. But you may find yourself considering a range of choices, including lumpectomy vs. mastectomy, whether or not to have reconstruction, when to have reconstruction and what you want to do with your healthy breast.

Often, there is no single right answer. What works best for you may not be the best option for someone else. That’s why it’s important to make your decisions in consultation with your oncologist and reconstructive surgeon, who can help you better understand the pros and cons of the different approaches.

Lumpectomy vs. Mastectomy

Generally, the first decision is whether to have a mastectomy or a lumpectomy. These options are often going to be influenced by your tumor.

• Mastectomy: This is the complete removal of breast tissue. It may be the only option for more advanced tumors. There are several forms of this procedure. A total mastectomy removes the entire breast, while other options attempt to preserve breast skin and the nipple and areola. If you plan to have reconstructive surgery, your plastic surgeon will usually step in immediately after the mastectomy for the first phase of your reconstruction. This involves inserting a tissue expander under the skin in your chest. Later, the expander will be replaced by a permanent implant or your own tissue to reconstruct your breast.
• Lumpectomy: Also known as breast conservation surgery, this procedure saves as much breast tissue as possible. If you are also undergoing reconstruction, it is advisable to begin that right away. The goal of oncoplastic reconstruction is to minimize the damage done to your breast during the lumpectomy. Because of the tissue removal, your breast may develop dimpling, dents, divots and scarring. Your plastic surgeon will minimize this by rearranging breast tissue or performing a breast reduction or lift.

Considering the Healthy Breast

You will also need to consider what to do about your unaffected breast. Even with a breast-conserving lumpectomy, there are usually noticeable differences between your breasts if you do nothing with the healthy breast.

With a mastectomy, some women choose to have both breasts removed – particularly if they have a higher genetic risk for breast cancer. They may also choose to have plastic surgery done on the unaffected breast at the same time as the procedure to reconstruct the affected breast. This provides a better chance of having two breasts that match in size and shape.

A similar approach can be used during a lumpectomy. Your plastic surgeon can do a breast lift to reshape and remove tissue to make your breasts more symmetrical.

Whatever you choose, just keep in mind that it is difficult to make a reconstructed breast match a natural breast. This is particularly true when using implants on only one side.

Reconstruction Timing

Deciding when to have reconstruction is often a matter of personal preference.

After a mastectomy, many women want to get as much of the surgery done as soon as possible. In some instances, reconstruction happens the same day as the mastectomy, though it is still likely that additional procedures will be needed later for fine-tuning and contouring.

A more common option is a staged approach, where your plastic surgeon places the tissue expander in your chest to begin enlarging the breast pocket. The expander is injected with saline over time to stretch the skin out to the desired breast volume. Once that point is reached, a second procedure swaps the expander with an implant or tissue harvested from your body. This usually occurs a few months after the mastectomy.

You don’t have to make this decision right away. Some women wait months or years before starting reconstruction.

There are, however, other considerations if you are undergoing a lumpectomy. Almost all reconstruction work is done immediately after the initial cancer surgery. That’s because you will be receiving radiation treatment as part of the lumpectomy care plan.

It’s important to get the breast shape in an ideal position before radiation treatment begins. After the breast has been irradiated, additional surgeries become riskier.