October is Breast Cancer Awareness Month—a time to support those affected by breast cancer, encourage education and early detection, and recognize the many decisions patients may face throughout treatment.
For women undergoing a mastectomy, one of those decisions may be whether to pursue breast reconstruction.
Breast reconstruction can restore the shape and contour of the breast after mastectomy, but there is no single approach that’s right for every patient. Understanding the differences between implant-based reconstruction and tissue-based reconstruction can help you have a more informed conversation with your medical team.
First and foremost, breast reconstruction is optional.
Some women choose reconstruction immediately following mastectomy. Others decide to wait until cancer treatment is complete, while some choose not to have reconstruction at all.
Each of these decisions is valid.
If you are interested in reconstruction, your options will depend on factors including your cancer treatment plan, overall health, anatomy, previous surgeries, personal preferences, and whether radiation therapy is anticipated or has already been performed.
That’s why breast reconstruction should never be viewed as a one-size-fits-all procedure.
Implant-based reconstruction uses a breast implant to recreate breast shape following mastectomy.
It is one of the most commonly performed forms of breast reconstruction and may involve either a one-stage or staged approach.
In a staged reconstruction, a temporary tissue expander may initially be placed beneath the skin or chest muscle. The expander is gradually filled over time to create space for the permanent implant.
During a later procedure, the expander is exchanged for a saline or silicone breast implant.
Some patients may be candidates for direct-to-implant reconstruction, in which the permanent implant is placed at the time of mastectomy.
Depending on the patient, benefits may include:
However, implants are not lifetime devices and may require additional surgery in the future. Complications such as implant rupture, infection, implant malposition, or capsular contracture can also occur.
Radiation therapy may influence both the appearance of implant reconstruction and the risk of certain complications, making coordination between your breast surgeon, oncologist, radiation oncologist, and plastic surgeon especially important.
Tissue-based reconstruction—also called autologous reconstruction—uses a patient’s own skin, fat, and sometimes muscle to recreate the breast.
Tissue may be taken from areas such as the:
There are several types of flap procedures, and the appropriate technique depends on the patient’s anatomy, previous surgeries, health, and treatment needs.
For appropriately selected patients, tissue-based reconstruction may offer:
Tissue-based procedures are generally more complex than implant reconstruction and involve surgery at both the breast and donor site. Recovery may therefore be longer, and patients will have additional scars where the tissue was taken.
Neither option is universally “better.”
The right choice is the one that best fits your medical circumstances, anatomy, lifestyle, treatment plan, and personal priorities.
One woman may prioritize a shorter operation and recovery and prefer implant reconstruction. Another may prefer using her own tissue and be comfortable with a more involved surgery.
For some patients, a combination of techniques may be appropriate.
The goal of consultation is not to steer every patient toward the same procedure. It is to help each patient understand the benefits, limitations, risks, and expected recovery associated with the options available to her.
Breast reconstruction may be performed at different points during breast cancer treatment.
Immediate reconstruction begins at the same time as the mastectomy.
This approach may allow the breast skin envelope to be preserved in appropriate patients and can reduce the experience of living without a breast mound between procedures.
However, immediate reconstruction isn’t appropriate for everyone, particularly when other aspects of cancer treatment need to be considered.
Delayed reconstruction is performed after mastectomy, sometimes months or even years later.
Some women choose this option because they want to focus on cancer treatment first. For others, chemotherapy, radiation therapy, medical conditions, or personal circumstances may make delayed reconstruction more appropriate.
Importantly, it is not necessarily too late to consider reconstruction simply because your mastectomy occurred in the past.
Radiation therapy is an important consideration when developing a reconstruction plan because it can affect the skin and underlying tissues.
Radiation may influence healing, tissue elasticity, implant-related complication risks, and the type or timing of reconstruction recommended.
If radiation is expected, your plastic surgeon and oncology team can work together to develop a strategy that takes both cancer treatment and future reconstruction into consideration.
This multidisciplinary planning is one reason discussing reconstruction options early can be valuable—even if you ultimately choose to delay the procedure.
Patients should also understand that breast reconstruction is often a process rather than a single operation.
Additional procedures may be performed to:
Understanding the entire potential treatment journey before beginning reconstruction can help patients develop realistic expectations.
Breast cancer treatment affects far more than physical appearance.
A mastectomy can bring complicated emotions surrounding health, femininity, identity, body image, and recovery. Some women view reconstruction as an important part of moving forward. Others do not.
There is no correct emotional response and no obligation to pursue reconstruction.
Patients should feel comfortable asking questions, taking time to understand their choices, and involving family members, counselors, support groups, or other trusted resources when helpful.
The decision should ultimately belong to the patient.
Two women with the same diagnosis may have completely different reconstruction plans.
Age, health, body type, previous surgery, cancer treatment, radiation, lifestyle, desired breast size, and personal preferences can all influence the recommendation.
That’s why a thoughtful breast reconstruction consultation involves much more than choosing between an implant and a flap procedure. It is about understanding the whole patient and developing a plan that works alongside her cancer care.
Breast Cancer Awareness Month is an important reminder that patients facing breast cancer deserve access not only to treatment, but also to clear information about the choices available to them.
If you are preparing for a mastectomy, have already undergone breast cancer treatment, or simply want to better understand your reconstruction options, a consultation can help provide clarity.
At his Manhattan practice, Dr. Scot B. Glasberg works with patients to develop individualized breast reconstruction plans based on their medical needs, anatomy, treatment history, and personal goals.
Schedule a consultation with Dr. Scot Bradley Glasberg to discuss the most effective options for your. Please contact our office at (212) 717-8550 or use our online form, to schedule a consultation to discuss the options available for you.
