Reconstruction for breast cancer
Breast reconstruction helps restore the appearance of the breast. It is an option for many women after a mastectomy. Breast reconstruction is rarely done after breast-conserving surgery (BCS) because most women do not notice a significant difference in their breast after this type of surgery. It is occasionally done after BCS if there is a significant defect.
Breast reconstruction often involves more than one operation. Surgery may be required on the unaffected breast so that is matches the reconstructed breast.
The decision to have surgery for breast reconstruction or to use a breast prosthesis is a personal one. It is based on the woman’s desires, lifestyle and physical or medical limitations. Women choose to have breast reconstruction to:
- feel physically whole again
- be reminded less of their breast cancer
- gain an increased sense of freedom
- avoid wearing a breast prosthesis
- have more variety in their clothing, including bras
- feel more comfortable with their bodies and sexually attractive
The timing of surgery for breast reconstruction depends on the type of treatment the woman receives, as well as her personal preferences.
- Immediate reconstruction is done at the same time as the surgery to remove the cancer. It may be possible to have immediate breast reconstruction if it does not interfere with other treatments for breast cancer, such as chemotherapy or radiation therapy.
- Delayed reconstruction is done after adjuvant therapyadjuvant therapyTreatment given in addition to the first-line therapy (the first or standard treatment) to help reduce the risk of a disease (such as cancer) coming back (recurring). for breast cancer is finished.
The results are the same regardless of whether the breast reconstruction is done immediately after breast cancer surgery or at a later time.
For most women, it is possible to have breast reconstruction before or after chemotherapy, radiation therapy or both. Breast reconstruction should be delayed 3–4 weeks after chemotherapy and 4–6 weeks after radiation therapy.
|Timing of breast reconstruction||Advantages||Disadvantages|
May mean less emotional stress as the woman does not have to deal with not having a breast.
Requires coordination between the surgeon who removes the breast cancer and the plastic or reconstructive surgeon who reconstructs the breast.
Avoids an extra operation and may be more convenient.
Requires a longer operation.
Breast tissue is not altered by radiation therapy or scarred from previous surgery.
May not be possible if breast tumour is very large.
Allows the wound to completely heal, particularly if the woman will be getting radiation treatment.
Increases the number of separate surgeries needed, such as the mastectomy, breast reconstruction and possible nipple reconstruction.
Gives the woman a chance to recover from one operation before having another one.
Allows the woman to focus on treating the cancer and then decide on reconstruction at a later time.
Allows the woman and her doctor to prepare for the surgery and choose the best option.
Factors affecting the type of surgery for breast reconstruction
The type of surgery used for breast reconstruction depends on a number of factors, including the following:
- the extent of the original breast cancer surgery and the amount of tissue removed from the breast
- any other breast cancer treatments, which can cause skin changes (such as radiation therapy)
- the amount of tissue (muscle and fat) that is available for reconstruction
- the health of the tissue at the reconstruction site
- the size and shape of the opposite (unaffected) breast
- characteristics of the woman having reconstruction surgery
- overall health and existing health problems
- body build
- preferences and expectations
There are a number of breast reconstruction methods. Women considering breast reconstruction should talk to their surgeon about the different techniques to find the one that will be the most suitable.
A breast implant is an outer shell of rubberized silicone filled with saline (sterile salt water) or silicone gel. Most commonly, surgery to place a breast implant is done in 2 stages:
- A temporary tissue expander is placed first, to create a pocket of tissue.
- The permanent implant is placed at a later date, when the expander has created space for the implant.
Autologous breast reconstruction
Autologous breast reconstruction uses the woman’s own body tissues (muscle and fat) that are collected from other parts of her body to create a new breast. The different types of tissue techniques used for breast reconstruction are:
- TRAM flap
- Latissimus dorsi flap
- DIEP flap
- free flap
Nipple and areola reconstruction
Reconstruction of the nipple and areola may also be done to create a more natural looking breast.
Women can usually wear a bra once the wound (incision) has completely healed. They should follow the advice of the surgeon about exercise and when to return to normal activities.
It may take several months for tissue to heal after breast reconstruction. There are often scars, which fade over time but may never go away entirely. A reconstructed breast will not look exactly like the original breast. The other natural breast may have to be reshaped or resized to match the reconstructed breast.
A reconstructed breast will not have normal breast feeling (sensation). This is because a nerve that runs through the deep breast tissue and supplies feeling to the nipple often gets cut during surgery. Over time, the skin on the reconstructed breast regains some sensitivity, but the breast will not have the same feeling as before.
Women who have breast reconstruction surgery should talk to their doctor about a follow-up plan that suits their individual situation.
- Women need to continue to have regular mammography on the natural (unaffected) breast.
- Women who have autologous breast reconstruction do not need to have regular mammography done on the reconstructed breast because it no longer contains breast tissue.
- clinical breast exam (CBE)
- CBE may bedone on both breasts during checkups.
- knowing your breasts
- Women should become familiar with both their natural breast and reconstructed breast, and learn what is normal for both. Ask the surgeon about how to check the reconstructed breast.
Breast reconstruction after breast cancer surgery is covered by most provincial health insurance plans, but the amount and type of coverage vary across Canada. Check your provincial health insurance plan before having breast reconstruction.