Breast cancer: Should I have breast reconstruction after a mastectomy?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Have breast reconstruction with your mastectomy or some time
later.
Do not have breast reconstruction. If you change your mind,
you can have it done later.
Key points to remember
Breast reconstruction may involve many different decisions,
including when to have the surgery and what type of reconstruction to have. Be
sure to understand your options, how long it will take to recover, and what
kind of follow-up you will need.
Most women are able to have breast reconstruction. But it may
not be a good choice if you are obese, smoke, or have serious health problems,
such as heart disease or diabetes. These conditions increase your risk of
serious problems after surgery.
It is important to be realistic about how your new breast will
look and feel. The surgeon can show you pictures of other women who had the
surgery you are considering. You can also ask to talk to women who have had the
surgery.
Making a
decision about breast reconstruction can feel very stressful. But talking with
your doctor or plastic surgeon will help you find your best
options.
If you choose not to have reconstruction or to wait, you can
use a bra insert (prosthesis) to help your clothes fit better.
Breast
reconstruction is surgery to rebuild the size and shape of a breast after your
breast has been removed (mastectomy) because of cancer. It is
done by a
plastic surgeon. Your breast surgeon can refer you to
a surgeon who has special training in breast reconstruction.
Reconstruction can be done at the same time as a mastectomy or at a later
time. If you need to have
radiation therapy after mastectomy, your breast
reconstruction may need to wait until after you have finished radiation and the
tissue has healed.
A reconstructed breast will not look or feel
just the way your breast did, but most women are happy with the results. To get
an idea of what to expect, tell your surgeon that you want to:
See pictures of other women who have had the surgery you are
considering.
Talk to women who have had the surgery to find out more about
their experience.
Making a decision about breast reconstruction can feel very stressful. But
talking with your doctor or plastic surgeon will help you find your best
options.
Breast implants.Implants may be filled
with salt water (saline) or silicone gel. A fluid-filled implant may be placed
right away, or a balloon (tissue expander) may be put in first. Over a few
months, the expander is filled with saline until its size matches the other
breast. Then the expander is removed and the implant is put in. For more
information, see:
Tissue flap surgery.The surgeon makes
a new breast shape from skin, fat, and muscle taken from another area of your
body (belly, buttocks, thigh, or back). There are several different types of
tissue flap surgery. These surgeries are more complicated than putting in an
implant, but the results look and feel more natural and last longer than
implants. For more information, see:
If you want, the surgeon can also make a new nipple and
areola (the darker area around the nipple). This is usually done 3 or 4 months
after breast reconstruction to give the new breast time to heal.
Most women are able to have breast reconstruction. But some conditions increase
your risk of serious problems after surgery. Breast reconstruction may not be a
good choice if you:
Have blood flow (circulation) problems or other serious health
problems, such as uncontrolled
diabetes,
high blood pressure, or heart disease.
Smoke. Smoking interferes with blood flow. This can cause more
problems after surgery, delay healing, and lead to larger scars.
If you have any of these problems, your doctor may advise
you to wait to have reconstruction until after you lose weight, quit smoking,
or get your disease under control.
Compare your options
Compare
What is usually involved?
What are the benefits?
What are the risks and side effects?
Breast reconstruction
Breast reconstruction
Hospital stay for
mastectomy and reconstruction is usually 1 to 3 days, depending on the type of
reconstruction you have.
You may have this done at the same time
as your mastectomy or some time later.
General anesthesia is usually used, so you sleep during the
operation.
If you have insurance that covered your mastectomy, it will
probably also cover reconstruction.
Some women say it helps them feel better about their bodies.
As with any
type of surgery, there is a risk of infection, usually in the first week or two
after surgery.
Problems can happen that require more surgery to fix. For
example:
The tissue used for a flap can die if blood supply to the
tissue is not restored.
Scar tissue around an implant can harden and squeeze the
implant. This can cause hardening of the breast tissue and changes in the shape
and look of the breast. This is more likely to happen in a breast that has been
treated with radiation.
Blood or clear fluid may collect in the wound.
If the incisions don't heal right, the implant may become
exposed. When that happens, the implant has to be removed.
Other problems sometimes occur, such as pain or discomfort in the
breast area.
Silicone implants can leak inside the body without causing any
symptoms. Women who get silicone implants should have
MRI tests starting 3 years after they get the implant
and every 2 years after that.
No breast reconstruction
No breast reconstruction
Hospital stay may be 1
to 2 days for your mastectomy. Or you may go home the same
day.
Your chest will be flat where the breast was removed, and
there will be a scar over the area.
You can wear a bra
insert to make your clothes fit better.
You can choose to have breast reconstruction later.
Some
women may have negative feelings about the way they look without a
breast.
Personal Stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about breast reconstruction after mastectomy
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I kind of
went into shock when my doctor told me I had breast cancer and would need to
have my right breast removed. I started listening again when she described how
I could have my breast reshaped. Knowing I could have this done right away
before I even woke up from the mastectomy made the whole thing easier to deal
with. I chose to have DIEP flap surgery, using tissue from my belly. I knew it
would take awhile to heal and look like a breast, and I did have to have
surgery on my left breast to help them match. But I am so glad I did it. It has
helped me feel stronger after the trauma of cancer.
Claudia, age 42
When my
doctor first mentioned that I could have my breast rebuilt after the
mastectomy, I was kind of interested. I didn't know they could do things like
that, taking tissue from your back or belly. But the more I thought about it,
the more it didn't feel right for me. It seemed like a distraction when all I
wanted to focus on was beating the cancer and getting back to my life. I talked
to my husband about it, and he totally supported my decision. Maybe sometime
down the road I might change my mind. But for now I use a prosthesis in my bra,
and this works fine.
Patrice, age 51
I had my left breast removed 3 years ago
and my right breast removed last year. I chose at that time to get implants on
both sides. I have been pleased with the results. I swim every morning, and
having the implants has helped me feel more balanced again. I feel so fortunate
to live in a time when we have these options. My mother, who had breast cancer
40 years ago, was not so lucky.
Jewel, age 73
When I got
cancer in one breast, I decided to have both breasts removed at the same time.
I didn't have any type of reconstruction. There's nothing wrong with it, I just
don't think you have to have breasts to be a woman. I am proud to be a breast
cancer survivor (going on 6 years now cancer-free), and I use my story and my
scars to help other women who are facing the same fight.
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose breast reconstruction
Reasons not to choose breast reconstruction
I know I won't look the same as I did before, but I don't want to wake up from surgery without a breast.
I just don't feel up to facing more surgery at this point.
More important
Equally important
More important
Having reconstruction will help me feel more like a cancer survivor and less like a cancer victim.
At this point I want to focus on fighting the cancer. I'll worry about the way I look later.
More important
Equally important
More important
I am willing to commit to a lot of follow-up with my doctor to get a new breast.
I want to heal and move on as soon as possible. I'll wear a prosthesis.
More important
Equally important
More important
I would not feel like a whole woman without a breast.
Being without a breast won't affect how I feel about myself as a woman.
More important
Equally important
More important
I'm not worried about possible complications from reconstruction surgery.
I'm very worried about the possible complications from surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having breast reconstruction
NOT having breast reconstruction
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
Check the facts
1.
If I want to have breast reconstruction, it has to be done at the same time as my mastectomy.
TrueNo, it's not true. You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later. It’s up to you.
FalseCorrect. You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later. It’s up to you.
I'm not sureYou may want to go back and read "What is breast reconstruction?" You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later.
2.
If I don't have breast reconstruction, I can wear bra inserts to help my clothes fit better.
TrueYou're right. Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
FalseSorry, that's wrong. Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
I'm not sureIt may help to go back and read "Key points to remember." Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
3.
I might not be able to have breast reconstruction if I smoke, am obese, or have a serious health problem such as diabetes.
TrueYes, that's correct. These health issues increase the risk of serious problems after surgery. If you have any of these, breast reconstruction may not be a good choice for you.
FalseNo, this is true. These health issues increase the risk of serious problems after surgery. If you have any of these, breast reconstruction may not be a good choice for you.
I'm not sureIt may help to go back and read "When is breast reconstruction not recommended?" These health issues increase the risk of serious problems after surgery.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
Breast cancer: Should I have breast reconstruction after a mastectomy?
You can use this information to talk with your
doctor or loved ones about your decision.
Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?
1. Get the Facts
Your options
Have breast reconstruction with your mastectomy or some time
later.
Do not have breast reconstruction. If you change your mind,
you can have it done later.
Key points to remember
Breast reconstruction may involve many different decisions,
including when to have the surgery and what type of reconstruction to have. Be
sure to understand your options, how long it will take to recover, and what
kind of follow-up you will need.
Most women are able to have breast reconstruction. But it may
not be a good choice if you are obese, smoke, or have serious health problems,
such as heart disease or diabetes. These conditions increase your risk of
serious problems after surgery.
It is important to be realistic about how your new breast will
look and feel. The surgeon can show you pictures of other women who had the
surgery you are considering. You can also ask to talk to women who have had the
surgery.
Making a
decision about breast reconstruction can feel very stressful. But talking with
your doctor or plastic surgeon will help you find your best
options.
If you choose not to have reconstruction or to wait, you can
use a bra insert (prosthesis) to help your clothes fit better.
Breast
reconstruction is surgery to rebuild the size and shape of a breast after your
breast has been removed (mastectomy) because of cancer. It is
done by a
plastic surgeon. Your breast surgeon can refer you to
a surgeon who has special training in breast reconstruction.
Reconstruction can be done at the same time as a mastectomy or at a later
time. If you need to have
radiation therapy after mastectomy, your breast
reconstruction may need to wait until after you have finished radiation and the
tissue has healed.
A reconstructed breast will not look or feel
just the way your breast did, but most women are happy with the results. To get
an idea of what to expect, tell your surgeon that you want to:
See pictures of other women who have had the surgery you are
considering.
Talk to women who have had the surgery to find out more about
their experience.
Making a decision about breast reconstruction can feel very stressful. But
talking with your doctor or plastic surgeon will help you find your best
options.
Breast implants.Implants may be filled
with salt water (saline) or silicone gel. A fluid-filled implant may be placed
right away, or a balloon (tissue expander) may be put in first. Over a few
months, the expander is filled with saline until its size matches the other
breast. Then the expander is removed and the implant is put in. For more
information, see:
Tissue flap surgery.The surgeon makes
a new breast shape from skin, fat, and muscle taken from another area of your
body (belly, buttocks, thigh, or back). There are several different types of
tissue flap surgery. These surgeries are more complicated than putting in an
implant, but the results look and feel more natural and last longer than
implants. For more information, see:
If you want, the surgeon can also make a new nipple and
areola (the darker area around the nipple). This is usually done 3 or 4 months
after breast reconstruction to give the new breast time to heal.
Most women are able to have breast reconstruction. But some conditions increase
your risk of serious problems after surgery. Breast reconstruction may not be a
good choice if you:
Have blood flow (circulation) problems or other serious health
problems, such as uncontrolled
diabetes,
high blood pressure, or heart disease.
Smoke. Smoking interferes with blood flow. This can cause more
problems after surgery, delay healing, and lead to larger scars.
If you have any of these problems, your doctor may advise
you to wait to have reconstruction until after you lose weight, quit smoking,
or get your disease under control.
2. Compare Options
Breast reconstruction
No breast reconstruction
What is usually involved?
Hospital stay for
mastectomy and reconstruction is usually 1 to 3 days, depending on the type of
reconstruction you have.
You may have this done at the same time
as your mastectomy or some time later.
General anesthesia is usually used, so you sleep during the
operation.
If you have insurance that covered your mastectomy, it will
probably also cover reconstruction.
Hospital stay may be 1
to 2 days for your mastectomy. Or you may go home the same
day.
Your chest will be flat where the breast was removed, and
there will be a scar over the area.
What are the benefits?
Some women say it helps them feel better about their bodies.
You can wear a bra
insert to make your clothes fit better.
You can choose to have breast reconstruction later.
What are the risks and side effects?
As with any
type of surgery, there is a risk of infection, usually in the first week or two
after surgery.
Problems can happen that require more surgery to fix. For
example:
The tissue used for a flap can die if blood supply to the
tissue is not restored.
Scar tissue around an implant can harden and squeeze the
implant. This can cause hardening of the breast tissue and changes in the shape
and look of the breast. This is more likely to happen in a breast that has been
treated with radiation.
Blood or clear fluid may collect in the wound.
If the incisions don't heal right, the implant may become
exposed. When that happens, the implant has to be removed.
Other problems sometimes occur, such as pain or discomfort in the
breast area.
Silicone implants can leak inside the body without causing any
symptoms. Women who get silicone implants should have
MRI tests starting 3 years after they get the implant
and every 2 years after that.
Some
women may have negative feelings about the way they look without a
breast.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about breast reconstruction after mastectomy
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
" I kind of
went into shock when my doctor told me I had breast cancer and would need to
have my right breast removed. I started listening again when she described how
I could have my breast reshaped. Knowing I could have this done right away
before I even woke up from the mastectomy made the whole thing easier to deal
with. I chose to have DIEP flap surgery, using tissue from my belly. I knew it
would take awhile to heal and look like a breast, and I did have to have
surgery on my left breast to help them match. But I am so glad I did it. It has
helped me feel stronger after the trauma of cancer. "
— Claudia, age 42
"When my
doctor first mentioned that I could have my breast rebuilt after the
mastectomy, I was kind of interested. I didn't know they could do things like
that, taking tissue from your back or belly. But the more I thought about it,
the more it didn't feel right for me. It seemed like a distraction when all I
wanted to focus on was beating the cancer and getting back to my life. I talked
to my husband about it, and he totally supported my decision. Maybe sometime
down the road I might change my mind. But for now I use a prosthesis in my bra,
and this works fine. "
— Patrice, age 51
"I had my left breast removed 3 years ago
and my right breast removed last year. I chose at that time to get implants on
both sides. I have been pleased with the results. I swim every morning, and
having the implants has helped me feel more balanced again. I feel so fortunate
to live in a time when we have these options. My mother, who had breast cancer
40 years ago, was not so lucky. "
— Jewel, age 73
"When I got
cancer in one breast, I decided to have both breasts removed at the same time.
I didn't have any type of reconstruction. There's nothing wrong with it, I just
don't think you have to have breasts to be a woman. I am proud to be a breast
cancer survivor (going on 6 years now cancer-free), and I use my story and my
scars to help other women who are facing the same fight. "
— Kerry-Ann, age
45
3. Your Feelings
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to choose breast reconstruction
Reasons not to choose breast reconstruction
I know I won't look the same as I did before, but I don't want to wake up from surgery without a breast.
I just don't feel up to facing more surgery at this point.
More important
Equally important
More important
Having reconstruction will help me feel more like a cancer survivor and less like a cancer victim.
At this point I want to focus on fighting the cancer. I'll worry about the way I look later.
More important
Equally important
More important
I am willing to commit to a lot of follow-up with my doctor to get a new breast.
I want to heal and move on as soon as possible. I'll wear a prosthesis.
More important
Equally important
More important
I would not feel like a whole woman without a breast.
Being without a breast won't affect how I feel about myself as a woman.
More important
Equally important
More important
I'm not worried about possible complications from reconstruction surgery.
I'm very worried about the possible complications from surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Your Decision
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having breast reconstruction
NOT having breast reconstruction
Leaning toward
Undecided
Leaning toward
5. Quiz Yourself
Check the facts
1.
If I want to have breast reconstruction, it has to be done at the same time as my mastectomy.
True
False
I'm not sure
Correct. You can have breast reconstruction at the same time as mastectomy, or it can be done months or years later. It’s up to you.
2.
If I don't have breast reconstruction, I can wear bra inserts to help my clothes fit better.
True
False
I'm not sure
You're right. Bra inserts are a good choice for women who don't want or can't have breast reconstruction surgery but who still want their clothes to fit well.
3.
I might not be able to have breast reconstruction if I smoke, am obese, or have a serious health problem such as diabetes.
True
False
I'm not sure
Yes, that's correct. These health issues increase the risk of serious problems after surgery. If you have any of these, breast reconstruction may not be a good choice for you.
Decide what's next
1.
Do you understand the options available to you?
2.
Are you clear about which benefits and side effects matter most to you?
3.
Do you have enough support and advice from others to make a choice?
Certainty
1.
How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2.
Check what you need to do before you make this decision.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Bets Davis, MFA
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Joy Melnikow, MD, MPH - Family Medicine
Specialist Medical Reviewer
Douglas A. Stewart, MD - Medical Oncology
References
Citations
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