The Five Do’s and Don’ts of Breast Cancer Reconstruction

By: Dr. Steven Pisano

Blogs
April 26, 2013

Do's:

Do seek experience. Breast reconstruction is complicated. Broadly speaking, there are two main categories of breast reconstruction—implant based and tissue based. Within each of these categories there are many options. Seek a practice whose physicians are experienced with all methods of reconstruction. Just as important, look for a practice in which breast reconstruction is the primary focus of the practice. Volume matters; you want to find a practice that does a large number of breast reconstructions year in and year out. In March of 2013, we at PRMA performed our 5,000th breast reconstruction with 4,500 being tissue transplant reconstructions with the DIEP flap.

Do research your options. Do your homework. Become an informed patient and learn the basics of implant based and tissue based reconstruction. Search “Breast Reconstruction” and this will get you started. The PRMA website has a ton of information. You’re not going to medical school, but you want to have a basic understanding of what each of the major types of reconstruction looks like and how it is performed. As your breast cancer treatment unfolds, make your oncologic surgeon and oncologist aware that you are interested in breast reconstruction and that you are aware of the various types of reconstruction.

Do set the timing. Breast reconstruction can be immediate or delayed. At PRMA we prefer to do the reconstruction immediately, that is, at the time of the mastectomy. An immediate reconstruction allows the patient to wake up with at least the breast mound in place; with a nipple-areola sparing mastectomy and immediate reconstruction the breast may look almost normal. On the other hand, not all breast cancer patients are candidates for immediate reconstruction. For example, patients who are advised to have radiation therapy may be better served by having a delayed reconstruction. Post-mastectomy chemotherapy in our practice, does not require a delayed reconstruction. But, for whatever reason, some breast cancer patients may not be ready for an immediate reconstruction, and the additional recovery that it entails.

Do choose your team. Choose a reconstructive surgeon who is Board Certified by the American Board of Plastic Surgery. Choose a plastic and reconstructive surgery practice that has a staff that is experienced and dedicated to breast reconstruction. Choose a facility that is well-run in general and has a good reputation for nursing care and is accustomed to performing reconstructive breast surgery specifically.

Do set realistic expectations. The reconstructed breast may not look like the native breast. It may end up being a different size, shape or texture. It may have a reconstructed nipple that lacks normal sensation and erectile function. Not all mastectomies are the same and some oncologic surgeons are more aggressive than others and remove more soft tissue from the breast. Radiation therapy may render the native remaining breast and chest wall skin tight and tethered to the underlying chest wall, which along with the mastectomy, contributes to what we at PRMA term a large “absolute tissue defect.” After reconstruction there may be asymmetry between the reconstructed and native breasts or in the case of bilateral reconstruction, between the two reconstructed breasts.

Don’ts:

Don’t let anyone talk you out of breast reconstruction. Make it clear to your surgeon, oncologist, radiation oncologist, significant other and children that you are interested in breast reconstruction. The vast majority of breast cancer patients are candidates for some type of reconstruction, whether implant or tissue, immediate or delayed.

Don’t settle for reconstruction that is not right for you. Pursue the type of reconstruction that fits your needs and appeals to you most. An experienced reconstructive surgeon will help you in your decision making process. He or she will review the pros and cons of the major types of reconstruction and determine whether you are a candidate for one type of reconstruction verses the other.

Don’t be impatient in your recovery. Breast reconstruction takes time, energy and patience. In our practice at PRMA, the time to complete breast reconstruction takes from four months to one year, maybe longer if chemotherapy and or radiation therapy is required.

Don’t be hindered by location. You may live in an area in which breast reconstruction is not available. Or it may be that you are interested in a tissue reconstruction such as the DIEP flap but no one performs it in your area. Consider traveling to a practice that offers breast reconstruction. PRMA has become a destination practice for breast reconstruction and patients routinely visit us from all over the United States, Mexico and Canada for breast reconstruction.

Don’t compromise your cancer treatment. Taking care of the breast cancer comes first. Reconstruction may need to be put off in the case of a large, aggressive tumor. Chemotherapy and radiation therapy may take priority over reconstruction. The vast majority of women are candidates for some type of reconstruction; it just may be that the reconstruction is delayed.

Learn More About Your Breast Reconstruction Options

26 Comments

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  • Mary

    I had a dbl mastectomy in 2006 & radiation on one Sid in 1998. I use to be a smoker and was told I couldn’t have reconstruction surgery I’m on Medicare

    Reply
  • PRMA Plastic Surgery

    Hi Mary, as long as you are not currently smoking, you may be a candidate for breast reconstruction. Please give me a call at 800.692.5565 and we can go over your medical history and discuss options. -Brandy

    Reply
  • Lisa

    I had breast reconstruction perform on me after my r mastectomy and reduction on my left. I now have a r breast high on my chest and flat and l breast full and hanging lower the nipples are not close to even and the r nipple is longer, smaller in diameter and the areola is smaller in diameter on the r side, too. My plastic surgeon stated he 800 cc was the largest he was allowed to put in and I should be greatful; sometimes you can mess up a good thing; look where I came from; he did a B- to A+ job; I don’t know what is good when I see it. He want to do another breast reduction on my l side. Insurance stated there are better ways to repair my breast than fat injections. I want to feel and look as good as I did before the cancer. I can not fit into a bra, swim suit or top without one side being too large or too small. Is there any one that can help me or am I stuck looking like this forever. I was a size 38 H before the mastectomy.

    Reply
  • PRMA Plastic Surgery

    Hi Lisa, PRMA surgeons routinely perform corrective breast reconstruction on patients that are unhappy with a previous reconstruction. Are you interested in going another reconstruction route - the DIEP flap maybe? Let me know if you’d like some more information, I’d love to help! -Brandy

    Reply
  • Diane

    I had a blateral and am very unhappy with the outcome. Also can anyone tell me, can u still get breast cancer back after a bi- lateral mastectomy

    Reply
  • Kim

    Hi My name is Kim, I had a left mastectomy over a year ago, and I am now losing weight, before considering reconstruction…. how much time would I need to consider having off from work, to do a tissue DIEP flap.. on the left, and giving the right breast a lift…. to match? what kind of time period on an estimate would I be likely to have, for healing as well? Thanks for your help! Kim Turner

    Reply
  • Julie

    I had a bilat mastectomy in 2007 with expanders then in early 2008 saline inplants replaced the expanders. My left implant can be felt through my skin, has a weird indentation next to me sternum and is a totally different shape and size than the right. I can’t find a bra that is comfortable to wear because the cups don’t fit correctly and I have what feels like jelly under my skin where the bra band would go around under my armpits to be fastened. I have had 13 ! surgeries to try and correct the problem. I hade to have nipple grafts also and they aren’t the same either. It looks like my left one is cold (erect) all the time and the right one is flat. The color has never been tattooed on but they did change color and look like my “real” nipples used to. I had an injection into the right one to change the shape to look more like the left one and all the filler has eventually come out of what looked like a blackhead. I had 800cc implants inserted but they seem to have settled quite a bit and feel like they sag. I know I am almost 50 and shouldn’t have a set of breasts like an 18 year old, but I was wondering what I might be able to do to fix them, make them more alike and possibly be a bit larger…?... I am willing to travel some distance, my original PS is 300+ miles away. Any help you can give me would be greatly appreciated.

    Reply
  • PRMA Plastic Surgery

    Hi Diane, the chances of a breast cancer returning after a mastectomy is less than 1%. I’d love to talk with you more to get some additional information regarding your previous reconstruction. Please feel free to call me at 800.692.5565 or email me @ .(JavaScript must be enabled to view this email address). -Brandy

    Reply
  • PRMA Plastic Surgery

    Hi Kim, the recovery time for the DIEP flap is approximately 4-6 weeks. Some women heal more quickly than others and are able to return to work sooner (especially if you aren’t doing any heavy lifting etc @ work). But I would definitely count on at least 4 weeks out of work. Let me know if you have any other questions. I’m happy to help! -Brandy

    Reply
  • PRMA Plastic Surgery

    Hi Julie, in order to determine what can be done in your situation, we ask that you complete our virtual consultation form. This will allow one of our surgeons to review your case (photos, medical history etc) and give their recommendations. You can find the form via this link—>http://prma-enhance.com/patient-forms/virtual-consultation. Let me know if you have any questions or need more information. You can reach me @ 800.692.5565 or via email @ .(JavaScript must be enabled to view this email address). -Brandy

    Reply
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