An external prosthesis works well for many women but surgery can restore confidence and symmetry after disfiguring cancer surgery. Various techniques using either synthetic implants or your own tissues (usually from the lower abdomen) are possible. Multiple factors influence choices, including body shape, scars, thickness of remaining chest skin, radiation changes and above all – patient expectations. All treatments related to breast cancer reconstruction are covered by health care. This is a complicated process requiring extensive discussion and a very individualized treatment plan.
FREQUENTLY ASKED QUESTIONS
Can reconstruction be done at the same time as the mastectomy?
Most reconstructions are done after the cancer surgery and any other treatments have been completed (delayed). Immediate reconstruction at the same time as the mastectomy is possible but there are pros and cons.
- only one operation
- you are never without a “breast”
- more skin is available and scars may be shorter so the appearance of immediate reconstruction is often better than delayed
- more risks related to healing and infection
- cancer status not known, so the need for other treatments (e.g. radiation) is unknown
- other treatments, especially radiation, adversely affects the results
- reconstruction may delay other cancer treatments if they are necessary which could affect outcomes
- the length of time from diagnosis to surgery is longer since more organization is required
- immediate reconstruction is therefore usually restricted to prophylactic mastectomies or cancers where no radiation or chemotherapy is anticipated
How is the nipple made?
Normally this is the last stage of reconstruction, building a ‘bump’ of skin and later tattooing the areola, giving the nipple colour.
What about my other breast?
Due to patient concern over the potential development of cancer in the remaining breast, some patients may desire a prophylactic mastectomy. Discuss this with your cancer surgeon or oncologist. Sometimes surgery may be advisable on the non-cancer side in order to “match” the reconstructed breast (e.g. breast lift)
What are the advantages/disadvantages of Tissue Reconstruction (TRAM flap) VS Implant Reconstruction?
- reconstruction with living tissue – which gives the breast a more natural shape and feel
- better choice after radiation therapy
- better symmetry with the opposite breast
- bonus ‘tummy tuck’
- longer operation
- longer recovery
- more potential risks
- possible loss of abdominal strength
What are the advantages/disadvantages of Implant Reconstruction VS Tissue Reconstruction?
- uses existing scars
- shorter operation
- shorter recovery
- multiple implant choices
- may require a tissue expander (an initial stretching device) and then a second operation to place the permanent implant
- can be difficult to match normal breast shape and consistency
- requires thicker, looser skin at the mastectomy site
- difficult to do after radiation treatment
- may require further surgery at a later date