Breast reconstruction can be done right after a mastectomy while you are still under anesthesia, or at a later time. Some women wait because they are not emotionally or medically able to undergo additional surgery, or because they need radiation therapy following their mastectomy. Reconstruction is major surgery that may require more than one procedure. Women should be fully informed about what is involved.
Women have several options in breast reconstruction surgery, including implants and flap procedures.
The most effective way to screen for breast cancer is by mammography, along with regular breast exams by your health care provider. But medical organizations don't agree on the recommendation for breast self-exams, which is an option for women starting in their 20s. Doctors should discuss the benefits and limitations of breast self-exams with their patients.
Implants involve stretching the skin with a special tissue expander, then inserting a silicone-gel or saline (salt water) implant. The tissue expander can be filled to a desired volume by injecting additional saline periodically, usually once a week for a few sessions. Many women find these sessions moderately painful, but are often pleased with the final result and the fact that they have more control over the final size of the breast. Because of safety concerns, in 1992 the U.S. Food and Drug Administration (FDA) banned silicone implants, except for those women participating in approved clinical studies. In 2003, an FDA panel that reviewed 10 years of data recommended the ban be lifted, as long as women were informed before the procedure and were monitored by an outside agency for 10 years after surgery. It was not until 2006 that the FDA lifted the ban and silicone gel-filled breast implants were again available for augmentation, reconstruction and revision. However, implants can rupture, causing pain and infection. You may need surgery to remove or replace the implant - half of these surgeries happen within 10 years. For more information, see Breast Implants After Breast Cancer Surgery.
Tissue flap procedures involve using a woman's own tissue taken from the abdomen or back (or sometimes the thighs and buttocks) to create a breast mound to reconstruct the breast. Taking abdominal tissue is called a TRAM flap, which is short for transverse rectus abdominis muscle flap. Taking tissue from the back is called latissimus dorsi flap. These procedures require a plastic surgeon who is experienced in this type of surgery.