What to know about reconstructive surgery after breast cancer

October is Breast Cancer Awareness Month, and October 16 is Breast Reconstruction Awareness Day. Instead of Halloween black and orange, many people deck themselves out in pink to show support for the countless women, men and families affected by breast cancer.

Statistics from BreastCancer.org suggest that breast cancer accounts for nearly 30 percent of all new cancer cases in women in the United States. The National Breast Cancer Coalition estimates that in 2024, there will be at least 313,510 new cases of breast cancer in women and 2,790 cases in men.

Breast cancer treatment, recovery and reconstruction are very personal journeys. No one can tell you what to expect or how to feel as you process a breast cancer diagnosis and what that means for your health. It is natural to want straightforward answers about your condition and what comes next. Unfortunately, that is not always possible.

It would be so much easier to tell people if you have this type of treatment, you can get this type of reconstruction. Simple and to the point, but that's not how reconstruction works. Explaining your reconstruction options following breast cancer is much like the reconstruction process itself – full of nuance and careful craftsmanship.

What do you need to know about reconstructive surgery after breast cancer, and what options are available to you? It depends.

What is breast reconstruction?

Breast reconstruction covers a wide variety of surgical procedures that aim to restore the natural shape and appearance of breast tissue following breast cancer treatment. Surgeons can use different techniques to help rebuild or replace breast tissue.

What type of reconstruction surgery does someone need following breast cancer treatment? Again, it depends.

Breast cancer treatments and reconstruction techniques have significantly advanced. Today, many oncologists and physicians recognize the value of offering patients comprehensive care, which includes involving a plastic surgeon early in the cancer treatment process.

"Getting the cancer out, that's the primary concern," said Kristy Hamilton, MD.

Yet, she noted that consulting with a plastic surgeon as soon as possible is wise. You should know that you have the right to seek guidance from a plastic surgeon early on in your cancer treatment journey. A plastic surgeon can work closely with your treatment team to evaluate which reconstruction options may be available to you, depending on the specific factors of your situation.

"I think of the importance of a multidisciplinary team approach when it comes to taking care of cancer patients, especially breast cancer patients," said Smita Ramanadham, MD. "It starts with your breast surgeon, but the referral should be made pretty early on to a plastic surgeon to also evaluate what the different options are when it comes to breast reconstruction, and that helps get everybody on the same page about the treatment and reconstruction options."

Breast reconstruction options

The two most common types of breast reconstruction surgeries are implant reconstruction and tissue flap reconstruction.

Dr. Hamilton collaborated with Aldona Spiegel, MD, on breast reconstruction research. She credits her with expanding her knowledge on breast reconstruction following cancer treatment.

"There are two main ways with either implant-based breast reconstruction or tissue-based breast reconstruction," said Dr. Hamilton. "Typically, if we're doing the tissue-based, that is the tissue coming from the lower abdomen that we move up. So not only do we want to take that tissue and create as beautiful and harmonious of a reconstructive breast shape as we can, but we also want to make sure that we are treating the donor site or where we remove the tissue from as close to a tummy tuck as possible. There's no reason why we can't make the belly button as nice for a breast reconstruction patient as a tummy tuck patient."

Flap reconstruction techniques use tissue from another region of the body, like the abdomen or thighs, to resculpt the breast. The technique's benefits include reconstructing the breast out of a patient's own healthy tissue, giving the breast a more natural look and feel. Patients may also enjoy the aesthetic benefit of a more sculpted abdomen.

"The modern breast reconstruction using lower abdominal tissue, or the DIEP flap, really mimics a tummy tuck as much as possible, keeping that scar low, creating contours, creating definition, taking the time to make a really beautiful tucked-in belly button," said Dr. Hamilton.

This technique is best for women left with little to no breast tissue because of a mastectomy.

Another surgical option for recreating the breast is tissue expansion followed by the placement of a breast implant. A surgeon places a tissue expander under the skin and gradually fills the device with a solution to help stretch and expand the skin over time. Eventually, the expander is removed, and a plastic surgeon can insert a breast implant.

"If the patient's so skinny that they don't have any tissue whatsoever, then perhaps we're moving to just implant-based reconstruction entirely," said Dr. Hamilton.

The type of surgery that offers a person the best aesthetic option depends on the type of breast cancer surgery the person undergoes and if they require subsequent cancer treatments like radiation or chemotherapy.

Chemotherapy can destroy a person's appetite and make them feel so ill food loses its appeal. The result may be dramatic weight loss.

"In general, if radiation is going to be performed, typically for the final reconstruction, you want to wait anywhere from three to six months prior to doing the final reconstruction," said Dr. Ramanadham. "But that's not to say that at the time of the mastectomy, an expander can be placed and expanded throughout the course of radiation treatment."

Chemotherapy and radiation treatments can shift the reconstruction timeline. For tissue flap surgeries, a surgeon wants to work with healthy tissue and operate on a patient with a more robust immune system. Same with radiation treatments. You do not want to reconstruct a new breast with healthy tissue only to treat it with radiation.

"You don't want to have your final reconstruction abdominal flap getting radiated because obviously the shape is going to change, and the final reconstruction is going to change," said Dr. Ramanadham.

Waiting may seem difficult, but it's important for ensuring the best possible result.

"The radiated tissues, you are burning the tissues in a controlled fashion, but that's the goal," said Dr. Hamilton. "So, we have to wait for those tissues to recover and stabilize. Then, the same thing with chemotherapy. We want to make sure that they can fight off an infection if, unfortunately, they were to develop one and just have their strength back and nutritional status back so that they can undergo reconstructive surgery and have it be successful and safe."

Other breast reconstruction options

Other techniques may also help restore breast size, shape and appearance. What works for a patient who undergoes a lumpectomy is not going to be the same surgical solution for a patient who undergoes a mastectomy.

"If the patient is larger-breasted, this is where oncoplastic options can come into play, such as a reduction at the time of the lumpectomy," said Dr. Ramanadham. "It's all very dependent on the patient's personal history, the shape of their breasts and what happened at the time of their lumpectomy.

Patients who only have a mastectomy and reconstruction on one breast might notice the reconstructed breast doesn't quite match the size and shape of their other breast. Not to worry. Surgeons have treatment options to improve their look so both breasts better match. Yet, it is important to understand the breasts will not be identical but similar.

"We can do a variation on a breast lift or a breast reduction to rearrange that breast and even do the other side to match it if the woman has enough breast tissue left," said Dr. Hamilton.

The reconstruction recovery timeline

You are probably ready to return to a somewhat regular routine after cancer treatment and reconstruction. When can you expect to be up and active again? Again, the answer depends.

"The whole timeline varies based on the treatments that you're getting for your cancer, as well as the type of reconstruction you're choosing and how many stages are involved," said Dr. Ramanadham. "In general, once you have your final reconstruction recovery, as with any surgery, is roughly four to six weeks where you're in ample limitations. Your final results are always going to be at that six-month to one-year mark where everything sort of settles out. But, again, oftentimes, it depends on what your overall plan is."

Finding the path forward

Are you sick of reading the phrase "it depends"? Many cancer patients may find the use of the word frustrating. They want straightforward answers after navigating cancer treatment, but it should inspire hope and optimism in breast cancer patients. Why? It's because now, more than ever, you have numerous treatment and reconstruction options available. Dr. Hamilton said she is excited by breast reconstruction advancements, and there has been a lot of progress in the field, from surgical techniques to implant placement.

What options are available to you personally? It depends on the unique factors of your situation. No one is going through the same experience as you. You deserve personalized treatment options that reflect your body's needs and your aesthetic point of view.

"There's always a path forward for patients," said Dr. Hamilton. "It just sometimes depends on how many surgeries patients are willing to have."

There is a path forward for you. What is that path? It depends, but a dedicated medical team, including board-certified plastic surgeons who are ASPS members, are willing to help you find it.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.