After breast cancer surgery: Your reconstruction questions answered

By Maura Hallam

Most breast cancer treatment includes some form of surgery. Common surgeries used to treat breast cancer range from breast-conserving surgery — also called a partial or segmental mastectomy or lumpectomy — where only the tumor and some surrounding tissue are removed, to a full mastectomy, where one or both breasts are completely removed.

The decision about which surgery is right for you will depend on a number of factors that you will discuss with your surgeon. It’s also very important to talk with your doctor before surgery to get an idea of how your breasts are likely to look afterward, and to learn what your options might be for reconstruction.

“Whether to proceed with reconstruction is a very personal question,” says Eunice Cho, MD, a breast surgeon with MultiCare Regional Cancer Center — Women’s Cancer Center. Dr. Cho specializes in treating women with breast cancer. “Reconstruction can be a very lengthy process, so patients have to be willing to put in the time and effort.”

Do I have to decide now?

There are a lot of things to learn, and a lot of decisions to make, after you find out you have breast cancer. You may not be ready to decide whether reconstruction is right for you or not. And that’s okay.

“Most women decide before their mastectomy,” says Dr. Cho, “But reconstruction can be done even years after mastectomy.”

She does caution, however, that patients who wait months or years after treatment may not have all the same reconstruction options available to them as patients who choose reconstruction right away.

Even if you are sure that reconstruction is want you want, you don’t have to commit to having additional surgeries right away. Reconstructions can often be done at the same time — or just a few days after — mastectomy surgery, says Dr. Cho, but they do not have to be.

“Some women choose to wait until after their breast cancer treatment is completed,” she says.

Immediate reconstruction may also not be an option for you due to other factors, for example, if you have other medical issues, or are a current smoker.

My (friend/sister/cousin/mom) had breast implants. Will it be like that?

While the general principles behind breast augmentation — AKA breast implants or “boob jobs” — and breast reconstruction are the same, there are some fairly large differences.

“With breast augmentation, native breast tissue, skin and nipple/areolar complex are left intact,” says Dr. Cho. “With reconstruction, all native breast tissue will be removed along with some of the skin overlying the breast. In most mastectomies, nipple/areolar complex will also be removed, although in some cases we are able to preserve it.”

Modern breast augmentation surgeries commonly use implants or fat injection. Breast reconstruction can also be performed using implants. But another common technique uses a section of the patient’s own tissue taken from their abdomen, upper back or buttocks, to reconstruct the breast.

Another important difference is the time that can be involved in completing a reconstruction versus an augmentation.

“Breast augmentation using implants is a one-step procedure,” says Dr. Cho, “But because breast cancer surgery removes both breast tissue and skin, multiple steps must be taken when implants are used in reconstruction, and the process can take several months.”

Typically in this case, devices called tissue expanders are placed behind the chest muscle during the original breast surgery. Over the next few months, the tissue expander will slowly be filled with fluid to stretch the overlying muscle and skin. Once the desired size is achieved, the patient will be taken back to the operating room, where the expanders are removed and the implants are put in.

Women who have had breast reconstruction may also need additional procedures to achieve the right breast shape and to create a “new” nipple and areola. And, women who have only had one breast removed may need surgery on their remaining breast after reconstruction so that both breasts are balanced and symmetrical in appearance.

What should I ask my doctor?

Some of the questions that Dr. Cho recommends you ask your surgeon about reconstruction are:

• Will reconstruction affect my cancer treatment and follow-up?
• What are the short- and long-term side effects and complications of reconstruction?
• How long does it take to recover?
• How will my reconstructed breast(s) be different from my natural breast(s)?
• What are the options if I am dissatisfied with the reconstruction?

If you have been diagnosed with breast cancer, let us help you get your questions answered, and help you make the right treatment decisions for you. The Women’s Cancer Center at MultiCare Regional Cancer Center in Tacoma includes a full complement of breast surgeons, oncologists and other health care professionals who specialize in treating — and supporting — women with breast cancer. This includes access to cutting-edge treatments through a robust breast cancer clinical trials program. Call 253-403-1677 to learn more.

This story was originally published October 2015 and updated October 2017.