What you need to know about your breast reconstruction options

Getting the diagnosis of breast cancer may be one of the most distressing experiences of your life. You are probably living through an array of feelings – worried, afraid, uncertain and, most of all, overwhelmed. That is natural, and many patients have felt the exact same way.

It is important to look around and be surrounded by family and friends... and a medical team that will support you every step of the way – from diagnosis to recovery.

As plastic surgeons, we are here to discuss your breast reconstruction options.

What are your breast reconstruction options?

Although the Women's Health and Cancer Rights Act (WHCRA) became federal law on October 21, 1998, with the goal of protecting women with breast cancer that choose to undergo breast reconstruction, less than 23% of women know the options available for breast reconstruction.

That doesn't mean that you have to choose breast reconstruction, but you should know your options. Remember, you are in control!

You will face many decisions as you go through the breast cancer journey. Ask questions! Sometimes the decisions may leave you feeling overwhelmed and unable to choose. That is when you should look at the resources available to you.

When thinking about breast reconstruction you should consider:

• How is your emotional health? How would a mastectomy affect the way you see your body? Is this going to change how you see your sexual identity or your body image?
• How is your physical health? Is your cancer and/or other associated medical conditions going to affect your ability to heal or withstand further treatment after reconstruction?
• What is covered by your insurance plan? In most instances, the WHCRA will protect you and help you with your breast reconstruction coverage. Be sure to ask your team about it.
• How comfortable will you feel with the possibility of many doctors, several appointments or multiple surgeries? Would you feel comfortable having to go through multiple surgeries in order to obtain an expected result? Breast reconstruction may require multiple steps before it is finally completed.
• What type of recovery are you expecting? Recovery from a mastectomy alone is often shorter than recovery from a mastectomy and reconstruction. Would you be willing to go through a longer recovery process to have a breast reconstruction?
• What is your timing for breast reconstruction? Would you rather undergo immediate reconstruction or postpone it to a later time once you are possibly better healed and your treatments are coming to an end?

You and your plastic surgeon will discuss the many options available for your treatment based on your breast cancer, your expectations, your associated medical conditions, your emotional health and the decision that makes you comfortable.

Immediate reconstruction

The advantages of having breast reconstruction at the time of the mastectomy include the potential of having more breast tissue to support reconstruction because there is no surgical scarring or radiation damage in the area unless radiation was given before surgery. Undergoing immediate reconstruction may mean less surgery and ability to recover from the mastectomy and reconstruction at the same time. Additionally, changes to your physical appearance are not as dramatic if the breast is reconstructed during the mastectomy.

Delayed reconstruction

An advantage of delaying breast reconstruction is that it gives you the chance to focus on your cancer treatment. It also provides time to research reconstructive options. The disadvantage is living without breasts in the short term. During this time, you should ask about the possibility of obtaining prosthetics.

Reconstruction with implants

One type of breast reconstruction uses breast implants to reshape your breasts. Implant procedures can be divided into two types, direct to implant or tissue expander to implant. Also, you should feel free to ask your surgeon about any concerns you have about implants.

Reconstruction with a flap

Flap reconstruction uses tissue from your abdomen, back, thighs or buttocks to rebuild the breast. This results in two scars, one at the breast and the other where the tissue was removed. Flaps are often used by themselves to reconstruct the breast, but sometimes they may require a breast implant to achieve the desired shape or size.

Choosing not to have reconstruction

You also have the option to forego reconstruction altogether. You may choose this for your own personal reasons, whether it is to get back to your life faster or because you feel it would be easier to live your life without breasts. Some women choose not to have a reconstruction, which is fine. There is no wrong decision. Remember that you are in control and it is ultimately your decision whether you want a reconstruction.

Is breast reconstruction right for you?

A breast cancer diagnosis can be overwhelming, but it's important that every patient knows their options for treatment and reconstruction. While you don't have to choose breast reconstruction, you should at least be aware of every option. If you think breast reconstruction is right for you, please be sure to visit the ASPS breast reconstruction procedure page and our dedicated Breast Reconstruction Awareness website.