Considering Breast Reconstruction After Cancer Treatment? 6 Things to Know

At a Glance

• Breast reconstruction can happen at the time of mastectomy or later. Learning about your options before breast cancer surgery can help you understand what may be possible and when.
• Reconstruction may use breast implants or your own tissue, and partial reconstruction may also be an option after lumpectomy. The appropriate approach depends on factors such as your anatomy, overall health, cancer treatment, and preferences.
• Cancer treatment can affect reconstruction. Chemotherapy may require some procedures to be postponed, while radiation can affect the tissue in the treatment area and influence when and how reconstruction is performed.

October is Breast Cancer Awareness Month. At West County Plastic Surgeons, it’s also an opportunity to help patients understand the choices they may face as they prepare for breast cancer treatment. If you are considering breast reconstruction, learning about your options before breast cancer surgery can help you understand what may be possible.

Reconstruction isn’t a required part of cancer treatment, and the decision of whether, when, and how to move forward belongs to you. But if you’re considering it, the time to start learning about reconstruction may be earlier than you think.

“Consulting with a plastic surgeon before breast cancer treatment begins gives you time to understand what reconstruction may involve, how it could fit with your care plan and which decisions may need to be made before surgery versus later,” says plastic surgeon Dr. Terry Myckatyn.

Here are six things to know:

1. You don’t have to decide everything before breast cancer surgery

Some patients have reconstruction during the same surgery as their mastectomy, while others choose (or are required) to wait until later. The type of cancer, your overall health, and your preferences all shape which techniques are available and when.

Reconstruction should not interfere with cancer treatment, so our plastic surgeons will coordinate timing depending on each patient’s unique situation.

2. There are several approaches to breast reconstruction

Breast reconstruction rebuilds one or both breasts, restoring shape, appearance, symmetry, and size, so they look and feel natural. There’s no single approach that fits everyone. The right technique depends on the type of cancer treatment you’ve had, along with your body type.

Implant-based reconstruction

Implant-based reconstruction uses a saline or silicone breast implant to restore breast shape and volume. We may place a temporary device in the breast (tissue expander) at the time of mastectomy and gradually fill it with fluid to stretch the skin. West County Plastic Surgeons often use a prepectoral approach, meaning the device sits above the chest muscle and directly under the skin, leaving the muscle intact. After a period of time, the tissue expander is exchanged for a permanent implant in a second procedure.

For some patients, a direct-to-implant reconstruction may be possible, with an implant placed immediately at the time of mastectomy.

“Implant-based reconstruction can take different forms, and the best approach depends on each patient’s anatomy, cancer treatment, and reconstructive goals,” says plastic surgeon Dr. Alexandra Keane. “We help patients understand those differences and choose the approach that best fits their needs.”

Flap Reconstruction

Flap reconstruction uses your own skin, fat, and sometimes muscle to build a new breast. One of the most common flaps is the DIEP flap (deep inferior epigastric artery perforator), which uses skin and fat from the abdomen while sparing the muscle underneath. The tissue is transferred to the chest and its blood vessels are reconnected. In many cases, the abdominal tissue provides enough volume to rebuild the breast without an implant, and a DIEP flap can be performed at the time of mastectomy or later.

Not every patient is a candidate for a DIEP flap. Candidacy depends on your individual anatomy, previous abdominal surgery, body weight, and aesthetic goals. West County Plastic Surgeons also offers other flap techniques that use tissue from different areas of the body, providing additional options when a DIEP flap isn’t appropriate.

3. Cancer Treatment Can Affect Breast Reconstruction

Breast cancer treatment can affect both the timing and type of reconstruction:

• Chemotherapy can temporarily affect the body’s ability to heal, so reconstruction may need to be postponed until you’ve recovered.
• Radiation can affect tissue in the treatment area, so we may recommend waiting until months after radiation is finished before completing your reconstruction or even using your own tissue to replace the radiated tissue.

4. Reconstruction isn’t only for mastectomy

Partial reconstruction following lumpectomy can help restore shape and symmetry when only part of the breast has been removed. Options may include:

• Oncoplastic breast reduction: At the time of lumpectomy, the remaining breast tissue is reshaped. The other breast may also be reduced to improve symmetry.
• Breast implant: A saline or silicone implant restores volume and shape.
• Fat grafting: Your own fat is transferred to smooth out changes in breast contour.
• Flap procedures: Depending on the size and location of the lumpectomy, a flap may be an option for partial reconstruction.

5. Recovery depends on the type of reconstruction

Everyone’s recovery is a little different, and your timeline will depend on the type of surgery you have and your overall health. Bandages or gauze are typically applied to your incisions, and you’ll wear an elastic bandage or support bra to reduce swelling and support the reconstructed breasts. The shape and position of the breasts continue to improve over the following weeks to months as swelling goes down.

As a general guide, tissue expander or direct-to-implant reconstruction is usually an outpatient procedure with the option to stay overnight in the hospital if needed. Patients often return to work after two to four weeks. With a DIEP flap, hospitalization is usually three to five days, and most patients return to work after three to six weeks, depending on their job. In both cases, you’ll want to avoid vigorous activities for about six weeks. Since recovery varies from one technique to another, you can find specifics for each procedure on our breast reconstruction page.

“Breast reconstruction is about more than rebuilding the breast,” says plastic surgeon Dr. Trina Ebersole. “Additional procedures can help refine shape, proportion, and symmetry to create the look and feel that’s right for you.”

6. Reconstruction doesn’t always end with the initial surgery

Options may include:

• Balancing procedures: A lift, augmentation, or reduction on the other breast can help both sides look more symmetric.
• Fat grafting: Small amounts of your own fat can be transferred to smooth and optimize breast contours.
• Nipple reconstruction: Rebuilding the nipple adds a natural-looking finishing detail to the reconstructed breast.
• Areola tattooing: Pigment restores the color of the areola, the circle surrounding the nipple.
• Laser or IPL scar therapy: Once healing is well underway, light-based treatments can help improve the appearance of scars.

Starting the Conversation

Whether you’re newly diagnosed, in the middle of treatment, or years past it, it’s never too early or too late to learn about breast reconstruction. A consultation with our board-certified plastic surgeons is a supportive space to ask questions, talk through your goals, and explore which options fit your body, your treatment, and your life.

For a look at one patient’s experience, you can read about the journey of Sheila McGlown, a patient of Dr. Marissa Tenenbaum.

Ready to learn more about breast reconstruction in St. Louis? Call (314) 996-8800 or contact us online to get started.