A mastectomy is a life-saving procedure that can eliminate or prevent cancer. However, needing to have breasts removed can be disheartening for many patients. Breast reconstruction after mastectomy is an option for those who wish to restore their pre-surgery appearance. Centers for Neurosurgery, Spine & Orthopedics (CNSO) performs breast reconstruction and other breast-related surgeries for patients in northern New Jersey. Here, the CNSO medical team answers some of the most common questions about breast reconstruction to help patients plan their procedures.
Breast Reconstruction Surgery at a Glance
- Breast reconstruction is used to restore a natural-looking breast mound after a mastectomy.
- Breast reconstruction provides psychological benefits and can improve a patient’s self-confidence.
- There are multiple types of breast reconstruction surgery, including implant-based surgery, autologous (natural tissue) reconstruction, and hybrid approaches.
- Patients should prepare for an extended process, anticipated scarring, and reconstructed breasts that do not look or feel exactly like their old breasts.
- Support resources are available to help patients through the breast reconstruction process.
What Is Breast Reconstruction?
Breast reconstruction is a type of surgery to restore a natural-looking breast after a mastectomy. Breast removal surgery, or mastectomy, is often a life-saving procedure. It can be used to treat breast cancer or to prevent cancer from developing in high-risk patients. Breast reconstruction encompasses multiple methods to recreate the breasts for the following benefits:
- Recreate a natural-looking breast mound
- Make the chest look more balanced or symmetrical
- Help clothes fit more comfortably
These physical benefits have an emotional impact as well. Breasts are an important aspect of many women’s self-esteem. Removing them can cause body insecurities, emotional distress, and lost confidence. Breast reconstruction helps patients feel better about their bodies, restoring confidence and self-esteem.
What Types of Breast Reconstruction Are Available?
There are multiple approaches to breast reconstruction, each offering different benefits and downsides. When planning reconstruction, patients can choose between:
Breast Implants
During an implant-based reconstruction, the plastic surgeon places a specialized implant under the breast skin or muscle. The implant provides a full appearance to resemble a natural breast.
Implant-based reconstruction provides the most flexibility with regard to volume, allowing the patient to be involved in choosing her ultimate desired size. However, they require occasional monitoring with imaging and may need to be replaced for leakage or changes that occur with a patient’s body related to weight gain/loss or the natural aging process. Unlike autologous tissue-based reconstructions, the implants remain static in size, not varying with weight gain or loss.
Natural Tissue
During autologous (flap) reconstruction, the plastic surgeon takes a flap of tissue from elsewhere on the patient’s body. This flap is used to recreate the breast mound.
Because it uses natural tissue, flap reconstruction creates the most natural-feeling breast. It is also a lifelong result that does not need replacement. It requires surgery on two separate locations on the body, however, so the recovery takes longer. It also requires the patient to have adequate donor tissue – usually from the abdominal area. Flap reconstruction may not be possible for thin patients, older patients, patients with more complex medical problems, or those with potential donor sites that have been exposed to previous surgeries.
Hybrid Approaches
Some patients may benefit from a hybrid approach. This is an advanced type of breast reconstruction surgery that uses an autologous tissue flap placed over an implant. The tissue flap gives the new breast a natural feel while the implant adds extra mass for larger breasts.
Though hybrid surgery provides the benefits of both implant and flap reconstruction, it also comes with the disadvantages of both techniques. Because hybrid surgery uses a tissue flap, it also requires a donor site and, therefore, a longer recovery. By involving the use of an implant, the patient must plan for routine imaging to monitor the integrity of the implant.
When Should Breast Reconstruction Take Place?
Breast reconstruction can be performed at different times. Some patients opt for immediate reconstruction, meaning that their mastectomy and reconstruction are performed at the same time. By combining procedures, patients can have quicker recoveries while enjoying the results of their reconstruction as soon as possible. The breast oncologic surgeon coordinates scheduling and planning with the reconstructive plastic surgeon for these cases. In rare cases, based on the surgical oncologist’s recommendation, reconstruction is delayed until further adjuvant chemotherapy or radiation treatments are completed.
How Long Does Recovery Take After Breast Reconstruction?
Breast reconstruction is a major procedure. Patients may require a short hospital stay, though most patients with implant-based reconstructions are able to go home the same day. During this period, it is important for patients to follow the surgeon’s instructions. These instructions help to prevent complications, such as infection or necrosis, for a faster and easier recovery. Instructions may include:
- Taking medications to prevent blood clotting or infection
- Managing pain with prescription or over-the-counter medication
- Keeping the surgical dressings clean and dry
- Wearing the appropriate support or compression garments
- Walking and performing gentle stretches daily
- Avoiding overhead movements, lifting, and sexual activities for a few weeks
- Watching for new pain, swelling, fluid leakage, and other signs of infection
It may take up to eight weeks for pain, swelling, and bruising to go away. It may take one to two years for the breasts to fully heal and for scars to fade.
What Are Reconstructed Breasts Like?
To ensure maximum satisfaction from breast reconstruction surgery, patients should set realistic expectations. While reconstructed breasts are significantly better than those opting for no reconstruction, they are not flawless. Patients should keep the following in mind:
- Reconstructed breasts may not look exactly like the patient’s natural breasts.
- Breast reconstruction will leave scars on the breast and tissue donor sites.
- Reconstructed breasts have less or different skin sensation than natural breasts.
- Reconstructed breasts may not feel the same as natural breasts.
It can take time to get used to reconstructed breasts. Patients are encouraged to talk with other women who have had reconstruction. Support groups can help patients set expectations and navigate the anxiety, depression, and other feelings that may accompany a breast reconstruction.
Should Everybody Have Breast Reconstruction?
Not every patient chooses to have breast reconstruction after a mastectomy. Some patients may be satisfied with their appearance after the loss of their breasts, or they may not want to go through additional surgeries. These individuals may elect to use a breast form (external prosthesis). Others choose to “go flat.” Whether or not to pursue breast reconstruction is a personal decision that every patient should make for herself.
Will Breast Reconstruction Interfere with Cancer Monitoring?
If cancer comes back, breast reconstruction will not interfere with detection or treatment.
Do Reconstructed Breasts Age in the Same Way as Natural Breasts?
Breasts reconstructed with autologous (natural) tissue will age and change in a natural way. Breasts reconstructed with implants, however, are static with regard to volume and do not change significantly, though the surrounding tissues may sag or contract with the aging process.
Is Breast Reconstruction Covered by Insurance?
Insurance plans that pay for mastectomy will also cover breast reconstruction, in accordance with a federal law called the Women’s Health and Cancer Rights Act (WHCRA) of 1998.
Find Expert Breast Reconstruction Near You in New Jersey
Breast reconstruction after mastectomy can restore natural-looking breasts, helping boost the patient’s self-confidence. Centers for Neurosurgery, Spine & Orthopedics is home to an award-winning plastic surgeon, Dr. Hakan Kutlu, who sees patients at CNSO’s Morristown, NJ, location. Contact CNSO today with questions about reconstruction or to schedule a consultation.
