Whether to have breast reconstruction after mastectomy is a personal choice. Consider the following when making your decision:

• Breast reconstruction may involve many different decisions, including when to have the surgery and what type of reconstruction to have. Be sure you understand your options, how long it will take to recover, and what kind of follow-up you will need.
• Most women are able to have breast reconstruction. But it may not be a good choice if you are obese, smoke, or have serious health problems, such as heart disease or diabetes. These conditions increase your risk of serious problems after surgery.
• It is important to be realistic about how your new breast will look and feel. The surgeon can show you pictures of other women who had the surgery you are considering. You can also ask to talk to women who have had the surgery.
• Dealing with cancer and having a mastectomy are very stressful. If trying to decide about breast reconstruction is adding to your stress, you don't have to make a decision now. You can always have it done later if you want to.
• If you choose not to have reconstruction or to wait, you can use a bra insert (prosthesis) to help make your clothes fit better.

What is breast reconstruction?

Breast reconstruction is surgery to rebuild the size and shape of a breast after your breast has been removed (mastectomy) because of cancer. It is done by a plastic surgeon. Your breast surgeon can refer you to a surgeon who has special training in breast reconstruction.

Reconstruction can be done at the same time as a mastectomy or at a later time. If you need to have radiation therapy after mastectomy, you may need to wait to have reconstruction after you have finished radiation and the tissue has healed.

A reconstructed breast will not look or feel just the way your breast did, but most women are happy with the results. To get an idea of what to expect, tell your surgeon you want to:

• See pictures of other women who had the surgery you are considering.
• Talk to women who have had the surgery to find out more about their experience.

Dealing with cancer and having a mastectomy are stressful. If trying to decide about breast reconstruction is adding to your stress, you don't have to make a decision now. You can always have it done later if you want to.

How is breast reconstruction done?

There are two types of breast reconstruction:

• Breast implants. Implants may be filled with salt water (saline) or silicone gel. A fluid-filled implant may be placed right away, or a balloon (tissue expander) may be put in first. Over a few months, the expander is filled with saline until its size matches the other breast. Then the expander is removed and the implant is put in. For more information, see:

  Breast implant surgery.

• Tissue flap surgery. The surgeon makes a new breast shape from skin, fat, and muscle taken from another area of your body (belly, buttocks, thigh, or back). There are several different types of tissue flap surgery. These surgeries are more complicated than putting in an implant, but the results look and feel more natural and last longer than implants. For more information, see:

  Tissue flap surgery.

If you want, the surgeon can also make a new nipple and areola (the darker area around the nipple). This is usually done 3 or 4 months after breast reconstruction to give the new breast time to heal.

How can I compare the two types of reconstruction?

Comparing breast reconstruction types

Type of reconstruction	Pros	Cons
Breast implant	Is an easier surgery with a quicker recovery time than tissue flap surgery. Creates less scarring than tissue flap surgery.	May not last for the rest of your life. May need to be replaced or removed later. May not be a good option for women with large breasts (C cup or larger).
Tissue flap	Should last the rest of your life. Because it uses your own tissues, you have more feeling in the new breast than with an implant.	Takes longer to heal and has a greater risk of complications from surgery. Creates scars on parts of your body where tissue was removed.

When is breast reconstruction not recommended?

Most women are able to have breast reconstruction. But some conditions increase your risk of serious problems after surgery. Breast reconstruction may not be a good choice if you:

• Are obese (body mass index over 35).
• Have blood flow (circulation) problems or other serious health problems, such as diabetes, high blood pressure, or heart disease.
• Smoke. Smoking interferes with blood flow. This can cause more problems after surgery, delay healing, and lead to larger scars.

If you have any of these problems, you may be able to have reconstruction done later if you lose weight, quit smoking, or get your disease under control.

What are the benefits of breast reconstruction?

• You may feel better about the way you look. Swimsuits and other types of clothing may fit you better, and your body may feel more balanced.
• It may help you to feel emotionally stronger.

What are the risks of breast reconstruction?

• As with any type of surgery, there is a risk of infection, usually in the first week or two after surgery.
• Problems can happen that require more surgery to fix. For example:
  • The tissue used for a flap can die if blood supply to the tissue is not restored.
  • Scar tissue around an implant can harden and squeeze the implant. This is called capsular contraction. It can cause hardening of the breast tissue and changes in the shape and look of the breast. This is more likely to happen in a breast that has been treated with radiation.
  • Blood or clear fluid may collect in the wound.
  • If the incisions don't heal right, the implant may become exposed. When that happens, the implant has to be removed.
• Other problems sometimes occur, such as pain or discomfort in the breast area.

What else should I think about?

• Your breast is a very intimate part of your body. So it is important to find a plastic surgeon you trust and feel comfortable with.
• If you are having only one breast removed and reconstructed, you might need to have surgery on the other breast to reduce, enlarge, or lift it so it better matches the new breast.
• If you had only one breast removed, you will still need to have regular mammograms to check for cancer in the other breast. Talk to your doctor about whether you need to have mammograms of the reconstructed breast.
• Silicone implants can leak inside the body without causing any symptoms. The U.S. Food and Drug Administration (FDA) recommends that women who get silicone implants have MRI tests starting 3 years after they get the implant and every 2 years after that.

If you need more information, see:

Breast implant surgery.

Tissue flap surgery.

Your choices are:

• Have breast reconstruction after mastectomy.
• Do not have breast reconstruction. If you change your mind, you can have it done later.

The decision whether to have breast reconstruction after mastectomy takes into account your personal feelings and the medical facts.

Deciding about breast reconstruction

Reasons to have breast reconstruction after mastectomy	Reasons to not have breast reconstruction after mastectomy
Breast reconstruction can help your body look more like it did before your breast was removed. Some women struggle with depression after they lose a breast. Reconstruction may improve your emotional health. Are there other reasons you might want to have breast reconstruction after mastectomy?	Women with some health conditions, such as obesity and heart disease, are at greater risk for complications from reconstruction surgery. Some types of reconstruction require extensive follow-up. This may not be practical for women who live far from a city. Multiple surgeries may be needed. Are there other reasons you might not want to have breast reconstruction after mastectomy?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about breast reconstruction. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I know I won't look the same as I did before, but I do not want to wake up from surgery without a breast.	Yes	No	Unsure
I just don't feel up to facing more surgery at this point.	Yes	No	Unsure
Having reconstruction will help me feel more like a cancer survivor and less like a cancer victim.	Yes	No	Unsure
At this point, I want to focus on fighting the cancer. I'll worry about the way I look later.	Yes	No	Unsure
I am willing to commit to a lot of follow-up with my doctor to get a new breast.	Yes	No	Unsure
I want to heal and move on as soon as possible. I'll wear a prosthesis.	Yes	No	NA*
I would not feel like a whole woman without a breast.	Yes	No	NA
I have seen other women’s mastectomy scars, so I know I can still be beautiful without a breast.	Yes	No	NA

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have breast reconstruction after mastectomy.

Check the box below that represents your overall impression about your decision.

Leaning toward having breast reconstruction

Leaning toward NOT having breast reconstruction

Breast Cancer

Mastectomy

Book

Dr. Susan Love's Breast Book (4th revised edition)
Author/Editor:	S.M. Love K. Lindsey
Publisher:	Perseus Books Group
Publication Date:	2005
In this book, Dr. Love presents medical information in a simple, welcoming style, with plenty of illustrations to help make the information even clearer. About two-thirds of the book deals with breast cancer: risk factors, prevention, screening, diagnosis, staging, emotions, treatment options, surgery, alternative treatments, clinical trials, and more. The book also includes information about breast development, physiology, bras, nursing, and sexuality.

Organization

American Cancer Society
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 (toll-free)
Web Address:	www.cancer.org
The American Cancer Society conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.

Other Works Consulted

• Ahmed S, et al. (2005). Breast reconstruction. BMJ, 330(7497): 943–948.

• Fallon AF Jr (2004). Breast reconstruction. In AJ Senagore, ed., Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers, vol. 1, pp. 216–222. Cleveland: Thomson Gale.

• Fine NA, Mustoe TA (2004). Breast reconstruction. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 801–818. Philadelphia: Lippincott Williams and Wilkins.

• Kronowitz SJ, Kuerer HM (2006). Advances and surgical decision-making for breast reconstruction. Cancer, 107(5): 893–907.

Author	Lila Havens
Editor	Katy E. Magee, MA
Associate Editor	Michele Cronen
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Keith A. Denkler, MD - Plastic and Reconstructive Surgery
Last Updated	September 27, 2007