A plastic surgeon talks about options after breast cancer treatment.
When someone is diagnosed with breast cancer, survival is the first priority. But quality of life and feeling comfortable with your body are also important considerations, and breast reconstruction surgery is often a key part of the recovery process.
“Reconstruction is a very personal decision, and 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, and they may choose to avoid the risks inherent in additional surgeries and ‘go flat.’”
Dr. Budd explained the basics of breast reconstruction and described the pros and cons of each approach.
The are 2 types of surgeries to remove breast cancer.
In a lumpectomy, the tumor is removed while the breast and the nipple are left intact to leave as much of the noncancerous breast tissue as possible. There may be dents where the tumor had been, but the breast usually will still function normally — which 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 to help 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.
About 80% of reconstruction procedures in the United States 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, since additional tissues aren’t required from other places on the body. Implant surgeries also tend to be shorter, so recovery times are quicker, and the overall risk is lower because there’s only one surgical site. Implants may wear out with time, and they tend to get firm or rupture and require replacement every 10 to 15 years — but if the implants are fine, we leave them alone.
When reconstruction is done using fat from another part of the body, the breast can look very natural. However, anytime we move tissue from one part of the body to another, there’s always a chance that problems with blood circulation may occur and that some of the tissue will die, which would require additional operations to fix.
Reconstruction can be done right away or years later, if desired — there’s really no time limit.
With an immediate reconstruction — a reconstruction done at the same time as the cancer removal — 2 surgeries are combined into 1. This option removes the need for an additional surgery and can result in a smaller scar, but there is a higher risk of complications, such as infection and skin death, which can delay other cancer therapies.
If breast reconstruction is delayed, there’s less chance of infection or skin death, also known as necrosis. For some patients, it can feel less overwhelming to separate the cancer treatment from the reconstruction. Waiting also ensures that if the patient needs additional radiation there’s no risk of damaging the reconstructed breast.
Federal law requires health care plans to cover all reconstructive procedures after a mastectomy, including surgery to create symmetry between the 2 breasts. Insurers must also cover any future reconstruction procedures that are needed if implants need to be replaced, cancer recurs, abnormal scarring appears, or a patient’s breasts no longer look symmetrical over time.
A cancer diagnosis can be scary and stressful but knowing all your options and partnering with a care team you trust can help you make the decisions that are right for you.