Breast Reconstruction

Breast reconstruction is a surgery performed after a mastectomy to rebuild the breast in order to closely match the other breast’s size and shape. It can be done at the same time as the mastectomy or at a later date—even years later. If a mastectomy is to be followed by radiation and chemotherapy, you may be advised to wait until these are finished before reconstruction takes place.

Why have breast reconstruction?

The decision to have breast reconstruction is a very personal choice, and each woman has her own particular reasons as to why she does or does not opt for it. If you feel uncomfortable with your mastectomy scar, or you feel that a prosthetic would be uncomfortable, you may want to consider reconstruction. Perhaps you want to return to something near your original physical appearance. You will want to look at whatever will give you increased self confidence. These are things to keep in mind when you are making your decision.

If you’re uncertain about your choices, you can delay reconstruction until you feel better able to make a decision. However, you may consult with a plastic surgeon to find out your options before your mastectomy or other treatments because your options can change based on the timing of these treatments.

Types of breast reconstruction

There are two basic types of breast reconstruction:  implant reconstruction and autologous tissue reconstruction.

An implant is an outer shell of rubberized silicone filled with saline (sterile salt water) or silicone gel. Before the implant is put in place, an inflatable bag called a tissue expander is placed in the breast cavity. The bag is slowly inflated by injecting saline through the bag’s valve. Every few weeks, more saline is added. After 8 to 12 weeks, the skin is stretched enough to allow for surgery to remove the tissue expander and insert the implant.

Autologous tissue reconstruction involves taking tissue from another part of the body (abdomen, upper thigh, or buttocks) and using it to create a new breast. There are many different flaps of tissue that can be used in this procedure. For more information, visit Breastcancer.org.  

A third type of reconstruction is a combination of the other two. It uses tissue from the upper back along with an implant. This procedure is known as a Latissimus Dorsi Flap.

Autologous tissue transfer is a much more complicated and longer procedure than implant reconstruction. It requires a significantly longer hospital stay, and a significant recovery period; however, the look and feel of autologous tissue reconstruction is more natural than implant reconstruction.

Complications from implant reconstruction may include internal scarring or risk of rupture or infection, as well as accumulation of blood around the implant (hematoma). An implant may need to be redone in the future.  These risks are increased if radiation therapy is to be given.

Complications from autologous tissue transfer may include scarring, muscle weakness or Infection at the donor site.

Nipple reconstruction

You may choose to have nipple reconstruction; there are two methods available, surgical and tattooing.  You can also buy artificial nipples that stick onto your skin.

For surgical nipple reconstruction, the surgeon makes small incisions at the nipple site.  The tissue is then elevated and shaped into a tissue projection that mimics the natural nipple. After three months of healing, the new nipple can then be tattooed to add color and create the areola around the nipple.

Alternatively, you can have a three-dimensional nipple tattoo, which can look quite real.

Artificial nipples are made of polyurethane. They closely resemble a natural nipple's color and texture. To attach the nipples, you moisten the back and stick them on – similar to a suction cup.

Not everyone who has breast reconstruction has nipple reconstruction. It’s a very personal choice.

Funding breast reconstruction

Breast reconstruction is funded by provincial and territorial health insurance.

Finding a plastic surgeon and questions to ask

To locate a plastic surgeon, ask for a referral from your oncologist. For a list of questions to ask your surgeon, visit Breastcancer.org. 

Breast reconstruction has both benefits and risks that you’ll need to consider before choosing this option. Be sure to ask lots of questions so you can make an informed decision.

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