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Breast Reconstruction After a Mastectomy

  • 11.29.2018

After a mastectomy or lumpectomy, breast reconstruction might be on your list of additional surgeries to consider. Typically, breast reconstruction takes place during or soon after a mastectomy, but it can also be done months or even years later. The American Cancer Society shares some of the factors you’ll want to think about when considering your options.

  • Your overall health (including issues that might affect your healing, such as smoking or certain health conditions)
  • The size and location of your breast cancer
  • Your breast size
  • The extent of your breast cancer surgery
  • Whether you’ll need treatments other than surgery for your cancer
  • Whether you want reconstructive surgery on one or both breasts
  • Your desire to match the look of the other breast
  • Your insurance coverage and related costs for the unaffected breast
  • How quickly you want to be able to recover from surgery
  • Your willingness to have potentially more than one surgery as part of the reconstruction
  • How different types of reconstructive surgery might affect other parts of your body

BreastCancer.org shares some additional questions that can help you start to think about what type of reconstruction you want, or if you want reconstruction at all:

  • How important is rebuilding your breast to you?
  • Can you live with a breast form that you take off and put on?
  • Will breast reconstruction help you to feel whole again?

            Read: Cancer Care & Body Image

Types of breast reconstruction

If you decide to move forward, there are two main techniques for you to consider:

  • Implant reconstruction: Inserting an implant that's filled with salt water (saline), silicone gel, or a combination of the two.
  • Autologous or "flap" reconstruction: Using tissue transplanted from another part of your body (such as your belly, thigh, or back). Autologous reconstruction also may include an implant.

You can also choose whether or not to reconstruct your nipple. In some cases, nipple-sparing mastectomy is possible, which means that your own nipple and the surrounding breast skin are preserved.

            Read: Cancer Care & Intimacy

Prosthetics  

Many women will choose a prosthesis (a breast form) rather than reconstructive surgery. A breast form can be fitted into a bra immediately after surgery, giving you the appearance of a balanced look without surgery. A prosthetic can also be a used as a temporary solution while considering your options.

BreastCancer.org shares that there are two main types of breast prostheses with different benefits for different stages of recovery:

  • A lightweight model (polyfill or foam) is recommended when you're recovering from surgery, because it's the most comfortable. It also feels good during warm weather and swimming and can be machine-washed. Most lightweight breast prostheses can be worn in chlorinated or salt water.
  • A silicone prosthesis may look more realistic and feel more natural to you for everyday wear. If you prefer to wear a prosthesis during sex, many women choose silicone prostheses because they have the most natural feel for their partner. Two types of silicone prostheses are available:
    • Asymmetrical: designed only for the left side or only for the right side
    • Symmetrical: these work on either side and can be worn sideways to fill out the side of your bra, or straight up for center fullness and cleavage

Or try something different

Instead of, or sometimes in addition to, reconstructive surgery after a mastectomy, some women are opting for decorative tattoos for scar coverage and nipple replacement. This can be a highly personal way to own your body again, in a way that makes the most sense for you.

Jane shares that she got a tattoo of a waterlily after her mastectomy. “I wanted to see beautiful art every time I looked in the mirror, rather than a scar, as a reminder that I am a breast cancer survivor,” she says. She chose the waterlily as it is the flower for those born in July, the birth month of both of her children and her grandbaby. “They are now near and dear to my heart physically, as well as emotionally,” she says.

If you choose this route, you’ll want to put a lot of thought into it since it should be considered permanent. This Pinterest board has many ideas to consider.

Living Flat

You may also choose to forgo reconstruction or prosthetics, something informally called “going flat” or “living flat.”  

BreastCancer.org shares a 2014 study that found that about 56% of women had reconstruction after mastectomy, which means that 44% didn't have reconstruction. As with anything, this decision is different for everyone and there is no right answer.

Mercedes, who has recovered from stage 3 breast cancer, says she probably would have gotten a breast implant if she was younger, but now, in her 50s, she’s not sure. “I feel like I should care, but I don’t,” she says. “I would like symmetry, but I don’t like elective surgery and poking a hole in my body for no reason.”

Choose the best option for you and your healing. And remember that some options enable you to change your mind at a later date.

Insurance and Breast Reconstruction

As part of your decision, you’ll want to check with your insurance company to find out exactly what is covered for your recovery and rehabilitation. The Women’s Health and Cancer Rights Act of 1998 requires all group health plans that pay for mastectomy to also cover prostheses and reconstructive procedures. In addition, Medicare covers breast reconstruction, while Medicaid coverage can vary from state to state. Plans will still vary, however, so be sure to confirm all coverage before moving forward.

Breast Cancer Recurrence

While breast cancer reconstruction does not increase the likelihood of a recurrence, there is always the chance that it can return to a breast that has a history of cancer. It is absolutely vital that all breast cancer survivors receive regular check-ups, MRIs and mammograms.

We’re here to answer your questions and discuss your options with you. For more resources and information about cancer prevention and treatment approaches, browse our blog. For current cancer-related health news delivered to your inbox, subscribe to Sierra Nevada Cancer Center’s Newsletter.

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