You’ve made it through many of the hard choices in your breast cancer treatment only to confront another major one: whether — and when — to have your breast (or breasts) reconstructed after your mastectomy. Some women want a fully reconstructed breast that looks as much as possible like the original. Others want a new breast that simply helps them look the way they like in a bathing suit. Still, other women have no desire for breast reconstruction at all.
In recent years, the number of women choosing breast reconstruction appears to be on the rise. In 2015 106,000 reconstructive procedures were performed, a 35 percent increase since 2000, according to the American Society of Plastic Surgeons. About 63 percent of women chose to have it, according to the association, and in some parts of the United States, about 80 percent of women asked for breast reconstruction after a mastectomy. One fairly new practice — called oncoplasty — combines breast cancer surgery with reconstruction during the same operation. However, studies find that breast reconstructive surgery is still underutilized.
You can have the reconstruction done at the time of the mastectomy, or you can wait until any additional treatment for your breast cancer, such as chemotherapy or radiation, has been completed. A 2010 study found that women who need radiation after a mastectomy may be better off waiting for reconstructive surgery. Among those who needed radiation, complications occurred in 44 percent of those who had immediate reconstruction, but only in 7 percent of those who did not have immediate reconstruction. Chemotherapy did not appear to impact complication rates.
Immediate reconstruction means a longer initial operation, but it spares you the distress of living for a time without a breast. On the other hand, delaying the reconstruction enables you to deal with your cancer and its treatment without the added burden of having to make more decisions right away. Depending on your medical condition, you and your doctor may decide that a lengthy initial surgery would put undue stress on your body.
How is breast reconstruction done?
During your mastectomy, the surgeon will probably remove all the breast tissue, the nipple, and the pigmented skin around the nipple called the areola. Some of the lymph nodes in the underarm may also be removed if necessary. The amount of breast skin remaining (called the breast pocket) will depend primarily on the location and size of your tumor. The breast pocket can be filled with your own tissue, with implants, or with a combination of both.
What’s involved in reconstruction with an implant?
Surgery to create a new breast from an implant takes less time and is less complex than reconstruction using tissue from another part of your body. However, the breast won’t feel like real tissue.
If enough of your breast skin was saved, you can have a full-size implant placed in your breast pocket right away. If a lot of skin was taken in order to remove the cancer, your surgeon can insert an empty silicone sack called an expander. Then he or she slowly inflates the sack by adding saline (saltwater) at weekly intervals over several weeks or months. As the sack enlarges, your skin stretches to accommodate it. Sometimes the expander is left in and acts as the implant; otherwise, it’s exchanged for a permanent implant once the breast pocket is the right size.
If you’re having an implant inserted immediately after a mastectomy, the procedure will take two to three hours, and you may stay in the hospital for as long as three days afterward. If you decide to wait and have the implant put in later, the surgery will take one to two hours and will either be done as an outpatient procedure or require a one-night hospital stay. You’ll probably be able to return to a desk job in about three weeks, but healing times vary from person to person.
Aren’t implants dangerous?
Numerous studies have found that saline implants have no harmful effects. Implants filled with silicone gel were restricted in 1992 after hundreds of thousands of women filed lawsuits claiming that the silicone had leaked into their bodies and brought on health problems ranging from connective-tissue diseases to breast cancer. In November 2006, the Food and Drug Administration lifted its restrictions on silicone implants, approving their widespread use for breast augmentation and reconstruction. At that time, the FDA announced that it considered silicone implants to be safe and effective.
What are the risks of using today’s implants?
Both saline and silicone implants can rupture. A rupture of a saline implant will cause the breast to deflate. Your body could easily absorb the saltwater, but a deflated implant would need to be removed or replaced, which would necessitate another operation. A study published in 2009 of 876 women who had saline implants found that 90 percent of the implants remained intact after 10 years. If a silicone implant ruptures there may be no symptoms. Because of this, the FDA recommends monitoring silicone breast implants with routine MRI scans every two years, starting three years after the initial implant surgery.
The scar tissue that forms around the pouch has also been known to harden and cause pain or change the