Know Your Options for Breast Reconstruction

Innovative methods give breast cancer survivors more ways to personalize breast reconstruction

By Rachael Bieschkie

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If you’ve had, or are scheduled to have, surgery as part of your breast cancer treatment, breast reconstruction is an option to help restore the shape of your breast, improving quality of life and self-esteem for some women. It’s estimated that only 23 percent of women understand the many options for reconstruction, which vary depending on your health status, body type and future cancer treatments, if any.

Along with deciding on the type of reconstruction, there is also the question of whether to do it immediately following breast cancer surgery or delay the procedure to a later date. Further, some women choose to forgo reconstructive surgery in favor of non-surgical reconstruction options. A discussion with your health care team can help you decide on the best option for your individual needs.

Pros and Cons of Implants

Frederick Durden, Jr., MD, a plastic and reconstructive surgeon at Cancer Treatment Centers of America® (CTCA) at Southeastern Regional Medical Center in Newnan, Georgia, explains there are two bigger categories of breast reconstruction surgery to consider: alloplastic, which involves some type of implant, saline or silicone, and autologous, which is reconstruction done using a woman’s own tissue.

“Alloplastic reconstruction with implants remains the most common option to this day. It limits the operation to the breast site and doesn’t require surgery outside of that,” Dr. Durden says. “It can also be the shorter surgery in terms of the surgery itself as well as time to recover. It’s important to understand that any type of implant typically will need to be replaced eventually, due to the potential compromise of the implant and changes in the soft tissue at the breast.”

The downfalls of implants, Dr. Durden says, is that they’re typically not permanent, meaning at some point in time it is probable to need replacement or removal of the implant. In addition, for women with a larger body type, implants may not always be the best option. “There are size restrictions, so for larger volume, there may not be a large enough option for the profile they wish to receive.”

Women who have had certain infections or radiation treatment may do poorly with implants, as radiation therapy may increase the risks of complication with implant-based reconstruction. Further, according to Dr. Durden, research is still ongoing in determining the relationship between silicone implants and a rare type of lymphoma. This potential risk, though small, is a factor in some women’s decision to choose non-implant-based reconstruction options.

Using Your Body’s Own Tissue

“For women who don’t do well with implants — those with a larger body type that can’t be accommodated with an implant, those who have previously failed with implants and need them removed, and those who have had complication with radiation therapy or don’t want silicone in their body for their own preference — autologous reconstruction is an option,” Dr. Durden says.

With autologous reconstruction, the breast is recreated using tissue taken from another area of your body, such as your abdomen, back, buttock or thigh. Because it involves your own tissue, there are no implant-related complications, and there’s no planned removal. “It’s a part of you,” Durden says, adding that you can achieve larger volumes with this type of reconstruction, often making it a better choice for women with a larger body size.

In addition, if you’ve had radiation treatment, autologous reconstruction can help to replace lost tissue with healthy tissue, and it’s typically a good choice for women who can’t have, or don’t want, implants. As an added bonus, if the tissue is borrowed from your abdomen, it may leave your abdomen with a slimmer profile — but Dr. Durden cautions against thinking of it as cosmetic surgery (or some such to avoid repetition):

It’s often advertised that abdomen flaps or perforator flap reconstructions are tummy-tuck type procedures. I avoid saying that because it’s a more extensive surgery than that, but it does make your abdominal profile better in most cases. It’s an added benefit, but I don’t like to say it’s like a tummy tuck.

As for cons, this procedure requires an incision in another part of your body beyond your breast, which has the potential for scarring and increased complications, including in the abdomen region. The recovery time can also be longer.

Dr. Durden tells his patients that, in general, recovery takes two to three weeks for implant-based reconstruction (before you’re doing semi-normal things like going out to eat) compared to six to eight weeks for autologous reconstruction. “Often people recover faster than that,” he says, “but it’s a good range for planning purposes just in case.”

During autologous reconstruction, you may also receive fat grafting, which involves removing fat tissue from another part of your body (usually via liposuction) and using it to improve the contour of the breast. This is a minimally invasive technique that’s often used alongside other reconstruction options (such as implants or flap procedures) but may also be used to reconstruct your entire breast. In the latter case, several surgeries may be required.

Preserving the Natural Look of Your Breast

It’s a good idea to talk to your physician about oncoplastic reconstruction prior to breast cancer treatment. With this approach, your reconstructive plastic surgeon and surgical oncologist work together to give you the best result following surgery, both in terms of removing the cancer and preserving or rebuilding your breast for aesthetic purposes.

Oncoplastic reconstruction methods? are used in conjunction with partial mastectomy when appropriate. In these procedures, breast tissue and skin will be preserved as much as possible to prevent scarring and deformities and allow for reconstruction using remaining breast tissue and skin.

Additional types of skin-sparing mastectomies help to preserve the shape of your breast. For instance,.you may also be able to receive a nipple-sparing mastectomy instead of a traditional mastectomy. Patients with these types of resections can consider both alloplastic or autologous reconstruction.

If your nipple is removed, surgical restoration is sometimes available, as are 3-D nipple tattoos, which can add a natural and realistic look to a reconstructed breast. By working together, your reconstructive plastic surgeon and oncologist can develop the best individualized plan that corresponds with your treatment plan and personal goals for reconstruction.

Choosing Reconstruction Now or Later

You may have a choice of whether to have breast reconstruction at the same time as your breast cancer surgery or wait until a later date. According to Dr. Durden, “Limiting surgery to one occasion is better for the patient. There are fewer risks from anesthesia and a shorter recovery time. So immediate reconstruction is better in terms of limiting the number of surgeries.” However, immediate reconstruction isn’t always an option. He explains:

You have to think about what type of cancer the patient has, what the plan is for their care afterward and the status of the breast skin after mastectomy. If there are possible plans for radiation, or compromised breast skin after mastectomy, then delayed reconstruction may be a better choice.

If possible, an immediate surgery is better, but often that’s limited to patients who are not planned for further radiation therapy, such as prophylactic surgery, or those whose mastectomy defect requires immediate reconstruction or post mastectomy breast skin allows for immediate reconstruction. Those who have already completed radiation care, as in the case of partial mastectomy, may also be candidates for immediate reconstruction.

Additional Choices: Prosthesis and ‘Going Flat’

If you’d rather not have another surgery but are interested in augmenting the shape of your breast, there are a number of different prostheses options available that can be molded into undergarments, such as bras, to help give you a more symmetrical appearance.

“I consider prostheses to be part of reconstruction,” Dr. Durden says, “and they’re an excellent option for patients who don’t want surgery.

In terms of quality of life, participation in activities, and the overall process that battling cancer has on your relationships, successful breast reconstruction allows patients to move back into doing things they were doing pre-cancer. It has a positive effect on quality of life.”

As for which option is best, in one study of women with successful breast reconstruction, autologous reconstruction was found to lead to more satisfaction than implants, but the study still concluded there is “no ideal breast reconstruction suitable for all patients.”

There are also women who opt for no reconstruction — surgical or prostheses — at all, which is often referred to as “going flat.” For some, this choice proves to be the most restorative and self-affirming route, but, ultimately, only you, with the guidance of your health care team, can decide which option will be the most healing for you.