Breast reconstruction: Understanding your options

The American Cancer Society estimates roughly 287,850 American women will be diagnosed with breast cancer each year, often facing a flood of overwhelming decisions when it comes to treatment.

The patient goes from day one of being totally normal and healthy, to having a lump or a bump, to being told they have cancer,” said Neal Hoganson, MD, a plastic and reconstructive surgeon on the medical staff at Baylor Scott & White Medical Center – College Station. “It’s overwhelming for everybody at first.”

For many women, part of that treatment plan includes reconstruction of the breast. Dr. Hoganson offers his advice on choosing a plan that’s right for you.

Weighing your breast reconstruction options

“A lot of breast cancer patients require a mastectomy,” Dr. Hoganson said. “Following a mastectomy, typically, they have options for reconstruction. And the goal of reconstruction is to recreate the aesthetic appearance after the breast tissue has been removed.”

Making the breasts look more balanced when wearing a bra, permanently regaining the shape of the breast, and not having to wear an external prosthesis are also reasons that someone might choose to have breast reconstruction surgery.

But choosing to have your breast or breasts reconstructed is just the first step. You must also decide between having the surgery immediately after having the cancer removed or delaying reconstruction to allow for healing and psychological processing time.

Should I have reconstruction surgery immediately?

“The pros of the immediate reconstruction would be that at the time of the definitive treatment to treat the cancer, steps are being taken to reconstruct the breast and save the patient an extra operation,” Dr. Hoganson said.

It’s important to know that immediate reconstruction can be a lengthy operation and may cause cell death (called necrosis), according to the American Cancer Society. If this happens, more surgery would be needed to fix the problem.

“We want to be sure that the surgery we do won’t affect the patient’s ability to have radiation or chemotherapy,” Dr. Hoganson said. “One of the downsides of immediate reconstruction is that the breast cancer hasn’t been fully staged. Occasionally, there is data that we get from the pathology report that changes the treatment course.”

What is a nipple-sparing mastectomy?

Historically, mastectomies remove the nipple and the areola because most breast cancers involve the ducts connected to the nipple.

If the nipple and areola have to be removed, they can be reconstructed later with other tissues after the new breast has had time to heal.

But recent data shows that some patients may have a choice of sparing the nipple. Talk to your surgeon and care team about what options you have.

“It depends upon the type of cancer and location,”  Dr. Hoganson said. “You want to make sure that it doesn’t complicate the cancer treatment by leaving it.”

How do I choose the right treatment plan for me?

Dr. Hoganson said he recommends his patients pick a reconstruction plan that doesn’t commit them to something that could interfere with treatment.

“The most common initial reconstruction is the placement of an expander,” Dr. Hoganson said. “The expanders can be removed, or they can be plated for radiation treatment. They can even stay in for chemotherapy.”

Tissue expanders are used after a mastectomy to increase the amount of tissue doctors have to work with when they’re recreating or implanting a breast. The expander is placed under the skin where the original breast was removed to prepare the area for the placement of a permanent implant or the patient’s own tissue.

“Patients have to decide what’s right for them and talk with their doctors to pick a plan that’s going to work out best for them,” Dr. Hoganson said.

Questions to ask yourself about breast reconstruction

• How important is it to you to keep your breasts?
• Do you want your breasts to match as much as possible in size?
• How anxious will you be about breast cancer coming back?
• Do you want to minimize the number of surgical procedures?
• Do you want a second or third opinion about your options?

Write down your thoughts and share them with your doctor, so you feel comfortable with any decision you make.

Find breast cancer support near you.