A Kaiser Permanente plastic surgeon explains breast reconstruction options and what to expect.
When someone has breast cancer, survival is the first priority. But quality of life and feeling comfortable with your body are also important considerations. Breast reconstruction surgery is often a key part of the recovery process.
“Reconstruction is a very personal decision. There is no one-size-fits-all approach,” said Michael Budd, MD, a plastic surgeon with Kaiser Permanente in Southern California. “For some women, having breasts improves their self-image, confidence, and quality of life. For others, breasts aren’t that important. They may choose to avoid the risks inherent in more surgeries.”
Dr. Budd explained the basics of breast cancer surgery and breast reconstruction. He also described the pros and cons of each.
The are 2 types of surgeries to remove breast cancer.
In a lumpectomy, the tumor is removed while the breast and the nipple are intact. This leaves as much of the noncancerous breast tissue as possible. There may be dents where the tumor had been. The breast usually will still function normally. This can be especially important to young patients who want to breastfeed in the future.
In a mastectomy, the entire breast is removed to get rid of the cancer and reduce the risk of recurrence.
After a lumpectomy, the goal is to fill in the empty spaces where tissue was removed. This helps the breast maintain its natural shape.
After a mastectomy, the goal is to reconstruct the entire breast. Reconstruction after a mastectomy is a multistage process that can take up to a year and a half to complete. It usually requires between 2 to 4 surgeries, separated 3 to 4 months apart.
Most reconstruction procedures are done with implants, either saline or silicone. Another option is to use tissue from other parts of the body, such as the back or stomach, to rebuild the breast shape.
One advantage of implants is that surgical scars will be limited to the breast. Additional tissues aren’t required from other places on the body. Implant surgeries also tend to be shorter, so recovery times are quicker. The risk is lower because there’s only one surgical site.
Implants may wear out. They tend to get firm or rupture and might need replacement every 10 to 15 years.
When reconstruction is done using fat from another part of the body, the breast can look very natural. However, moving tissue from one part of the body to another can cause problems. There’s always a chance that problems with blood circulation may occur. Some of the tissue might die, so more operations would be required.
Reconstruction can be done right away or years later, if desired. There's really no time limit.
An immediate reconstruction is done at the same time as the cancer is removed. Two surgeries are combined into one, removing the need for another surgery. This can also result in a smaller scar. But there is a higher risk of complications. Problems such as infection and skin death can happen, which can delay other cancer therapies.
If breast reconstruction is delayed, there’s less chance of infection or skin death. For some people, separating the breast cancer treatment from the reconstruction can feel less overwhelming. Waiting also ensures that if the patient needs more radiation there’s no risk of damaging the reconstructed breast.
Federal law requires insurers to cover all reconstructive procedures after a mastectomy. This includes surgery to create symmetry between the 2 breasts. Insurers must also cover any necessary future reconstruction procedures. Insurers are responsible for coverage if implants need to be replaced, the cancer recurs, abnormal scarring appears, or a patient’s breasts no longer look symmetrical.
A breast cancer diagnosis can be scary and stressful. Knowing all your options and partnering with a care team you trust can help you make the decisions that are right for you.
Learn more about cancer care at Kaiser Permanente.