We teach you about mastectomy reconstruction options. While treating your cancer comes first, a multidisciplinary team approach results in better cosmetic and cancer outcomes.

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Questions for your Breast Surgeon and Plastic Surgeon:

1. Am I a good candidate for breast reconstruction?
2. What type of reconstruction do you recommend?
3. Am I a candidate for a nipple-sparing or skin-sparing mastectomy?
4. What are the complications and disadvantages of reconstruction?
5. What are the advantages and disadvantages of a bilateral mastectomy?

What is Breast Reconstruction?

Breast reconstruction is commonly performed after a mastectomy. The goal is to re-create the shape of the breast with one or multiple surgeries by a plastic-reconstructive surgeon. Today, the cosmetic results are leaps and bounds beyond where they were just a decade ago. With that said, breast reconstruction is far more complex and carries much higher complication risks than an elective breast augmentation. About half of women who have a mastectomy in the United States will undergo breast reconstruction.

A mastectomy without reconstruction is also a surgical choice. One can wear a breast prosthesis and avoid the more extensive surgeries and risks of complications with a reconstruction. The decision to have breast reconstruction is complicated and personal. It is important to realize that everyone has different goals, different personal situations, and their own reasons as to how they manage their unique breast cancer situation.

Treating your breast cancer comes first.

There are many complex factors your breast cancer surgeon must consider about your reconstruction options. Most of the time your reconstructive options are not affected by your cancer treatment. But if you do have a complex breast cancer situation, ask your surgeon to present your dilemma to a multidisciplinary conference for further input from other surgeons, medical oncologists, and radiation oncologists. Balancing a great cancer outcome with a good cosmetic outcome sometimes requires intensive discussions amongst your breast surgeon’s team of breast cancer specialists.

A surgical “Team Approach” is best.

Your breast surgeon will likely guide you to a plastic-reconstructive surgeon he or she works with regularly. They will work as a “team” to plan the best surgical approach to your cancer and likely work together the day of your mastectomy to begin your reconstruction. Subsequently, the plastic surgeon works with you in planning further staged reconstruction procedures.

What are your Breast Surgeon’s “Mastectomy Options”?

A skin-sparing mastectomy preserves the skin of the breast but not the nipple or areola. Preserving the normal “skin envelope” in the shape of your breast leads to better cosmetic results.

A nipple-sparing mastectomy preserves all the skin of the breast including the nipple and areola. If you have an early stage breast cancer located away from the nipple you may be a candidate for this approach. Nipple-sparing mastectomies generally lead to the best cosmetic results. Women with very large breasts may not be appropriate for a nipple-sparing technique.

A traditional mastectomy saves only enough skin to cover the chest wall. Sometimes this is required to effectively treat the cancer. Reconstruction can still be performed in this setting, but the cosmetic results may not be as successful as nipple-sparing or skin-sparing approaches.

What are your Plastic Surgeon’s “Breast Reconstruction Options”?

Two-stage implant reconstruction involves implantation of a “tissue expander” implant at the time of your mastectomy to help mold and stretch the skin to the desired size and shape. This implant will be expanded one “fill” at a time at office visits until the desired result is achieved. At a second operation, the plastic surgeon will remove the expander and place a permanent implant filled with “saline” or “silicone.” This the most common approach to breast reconstruction today.

One-stage implant reconstruction occurs with well-selected patients that can undergo placement of the “final implant” during the mastectomy surgery. This approach is not nearly as common as the two-stage approach outlined above.

Tissue flap reconstruction is used in about 10% of all breast reconstructions in the United States. The benefit is that it uses a segment of your own tissue from your abdominal area or your back to fill the space needed to reconstruct the breast. It is a much more complicated and involved surgery but the results seldom require surgical revisions in the future. Types of tissue flaps include DIEP flaps, TRAM flaps, and latissimus flaps.

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