Breast Reconstruction After Mastectomy: What Are Your Options?

A mastectomy is a surgical treatment option for women who have breast cancer or have a high risk of developing it. This procedure completely removes one or both breasts, thereby removing tissue that is or may become cancerous.

Following a mastectomy, women may opt to have their breasts reconstructed, either by using their own tissue from another part of the body (tissue-based reconstruction) or with breast implants. Depending on each woman's medical needs, cancer treatment plan and personal preferences, breast reconstruction surgery may be performed at the same time as the mastectomy or later as a separate procedure.

“Women have options after mastectomy, and understanding the potential benefits and risks of these options can help them make informed, confident decisions,” says Christopher Reid, MD, a plastic and reconstructive surgeon with the Scripps Cancer Center and Scripps Clinic.

Breast implants are a common reconstructive option that can provide excellent results. Compared with tissue-based reconstruction, implants generally don’t involve surgery on other parts of the body and may offer a shorter initial recovery. Some women may go home the same day or the day after surgery, depending on the procedure.

However, implants also have potential complications. They may leak, rupture or become infected. The scar tissue surrounding the implant may harden, and appearance may change over time.

Patients may need more than one operation to complete reconstruction process. Implants are not considered lifetime devices, and additional surgeries may be needed over time to replace, remove or reposition them.

Another option is tissue-based reconstructive surgery, which uses a woman’s own tissue to rebuild the breast. When using the tummy tissue, called deep inferior epigastric perforator (DIEP) flap reconstruction, this option uses skin and fat from the lower abdomen while preserving the abdominal muscles.

During surgery, the surgeon transfers abdominal tissue to the chest and reconnects the blood vessels. Because the reconstructed breast is made from the patient’s own tissue, it can change naturally with the body over time.

Moreover, patients avoid potential complications and long-term issues related to an implant.

“Because it’s the patient’s own tissue, there’s nothing to be replaced,” Dr. Reid explains. ”It will age and change alongside the patient, and replaces what was taken with something similar.”

Still, DIEP flap surgery is a complex operation. It involves surgery on both the breast and abdomen, can leave scars and carries risks such as bleeding, infection, blood clots and problems with blood flow to the transferred tissue. Recovery may also involve temporary abdominal weakness, discomfort or other complications. Often, additional surgery may be needed to refine the results.

Typically, patients undergoing DIEP flap reconstruction spend several days in the hospital. However, Dr. Reid offers an approach specifically designed to allow patients the fastest and most comfortable recovery.

“At Scripps, patients who get reconstructed with their own tissue have the opportunity for excellent pain control and go home the day after surgery,” he says. “Their recovery is often very similar to implant reconstruction.”

With either procedure, going home sooner does not eliminate the need for recovery or follow-up care. Most patients will need support at home for at least a few days after they leave the hospital.

Reconstruction is not necessary after mastectomy. Some women choose to live without breast reconstruction, avoiding the additional surgery and recovery associated with these procedures. It may be particularly appealing to women who want to minimize procedures or focus on recovery from cancer treatment.

“Choosing not to reconstruct is often the easiest, safest, fastest thing that women can do,” Dr. Reid says.

Women who initially decline reconstruction remain candidates for surgery later, depending on their health and individual circumstances.

The best choice depends on a woman’s overall health, cancer treatment plan, anatomy, lifestyle and personal priorities. Some women who choose reconstruction value the use of their own tissue, while others prefer to avoid a more extensive operation. Others decide that reconstruction is not right for them.

Discussing options with a plastic surgeon and breast cancer team can help clarify the potential benefits, risks and long-term implications of each approach. It is also important to understand whether radiation or other cancer treatments may affect the timing or outcome of reconstruction.

"Seeking care with a reconstructive team that can offer all options is a very important thing to remember for patients," Dr. Reid says.

Parents should also ask whether they will need mammograms after surgery. Breast cancer screening after mastectomy depends on the type of surgery and whether breast tissue remains.

“If you have questions, we are more than happy to see you and make sure that you understand all the options available to you.”