Breast reconstruction is surgery to make the breast look and feel as natural as possible after part or all of it is removed with a mastectomy. It is done by a plastic surgeon who is specially trained to do this surgery. It often involves more than one operation. You may also need to have surgery on the breast that didn’t have cancer to make both breasts look alike.
The decision to have breast reconstruction is a very personal one. It is important to talk to your cancer surgeon and a plastic surgeon about breast reconstruction before surgery. Some women choose to have reconstruction because they think that it will make them feel more comfortable, confident and like themselves before they had a mastectomy. Some women have this surgery because they don’t want to use an external breast prosthesis. Other women choose not to have breast reconstruction because they don’t want to have more surgery.
Choosing the type of breast reconstruction that is right for you
Your plastic surgeon will talk to you about the different types of breast reconstruction and which one will work best for you. They will consider the following factors when they decide which types of breast reconstruction to offer you:
- your overall heath and any health problems you may have
- the health of the tissue where the reconstruction will be done
- whether or not you had (or you will have) radiation therapy to the breast area
- how much tissue was removed during surgery to remove the cancer
- the amount of muscle and fat available for reconstruction
- the shape and size of your body
- the shape and size of the opposite, or unaffected, breast
Find out more about the types of breast reconstruction.
Timing of breast reconstruction
When breast reconstruction is done will depend on which treatments you have for breast cancer and when you are ready to have this surgery. Some women choose not to have breast reconstruction until a long time after they have finished their breast cancer treatments. Other women choose to have it done as soon as possible.
Immediate reconstruction is done at the same time as the surgery to remove part or all of the breast. This approach is an option if it does not interfere with other treatments for breast cancer, such as chemotherapy or radiation therapy.
Delayed reconstruction is done after other treatments for breast cancer are finished. It is usually done 3–4 weeks after chemotherapy and 4–6 weeks after radiation therapy. This delay allows your body to heal properly so that there are fewer problems, or complications, with the breast reconstruction surgery. Delayed reconstruction can also be done months or years later.
Immediate-delayed reconstruction is a combination of the above options. During surgery to remove part or all of the breast, the surgeon places a tissue expander under the chest muscles and skin. Another surgery is done to complete the breast reconstruction after other breast cancer treatments are finished.
After breast reconstruction
If possible, talk to your plastic surgeon before you have a mastectomy. Tell them what you expect or hope for from breast reconstruction. It is important to understand that a reconstructed breast will never have the same feeling, or sensation, as a natural breast. 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. A reconstructed breast also doesn’t look exactly like a natural breast. You may have scars after breast reconstruction. They will fade over time, but they may never go away completely.
It may take several months for tissue to heal and become soft after breast reconstruction. Talk to your surgeon about when you can return to your normal activities and the type of exercise you can do. You can start to wear a bra when the incision has completely healed.
Follow-up is an important part of breast reconstruction. Your plastic surgeon or healthcare team will work with you to decide on follow-up care to meet your needs. During a follow-up visit, your healthcare team will usually ask questions about the side effects of treatment and how you’re coping. Your surgeon will examine your reconstructed breast and your natural breast to look for any changes or problems. You need to know what is normal for both your natural and reconstructed breast. Ask your surgeon how to check your reconstructed breast. If you find any changes, report them to your healthcare team.
Women who have breast reconstruction using tissue from other parts of their body (autologous breast reconstruction) do not need to have regular mammography done on the reconstructed breast because it no longer contains breast tissue. But you will need to have regular mammography on the natural breast.
Breast reconstruction after breast cancer surgery is covered by most provincial and territorial health insurance plans. The amount and type of coverage vary across Canada. Check your provincial health insurance plan before having breast reconstruction.