Opting for a breast reconstruction after mastectomy (the procedure to surgically remove some or all breast tissue, usually due to breast cancer or cancer risk) comes with a lot of questions and decisions. Here’s what Dr. Majewski of Majewski Plastic Surgery in Jonesboro wants you to know about breast reconstruction.

If you’ve undergone a mastectomy or if it’s part of your treatment plan, you’ve had a lot to manage in regard to your treatment and recovery. Most of the decisions you’ve had to make up to this point this point have been driven by your health; you’ve had to set aside your feelings in order to make the best decision for your body and increase your chances of survival.

But mastectomy surgery can completely alter the appearance of your body, how your clothes fit, and your self-image as a woman. It’s completely understandable to want to explore your options for when you get to the other side. In fact, according to research by the American Society of Plastic Surgeons, eighty-nine percent of women want to see photos of breast reconstruction surgery results before undergoing cancer treatment.

If you are one of these women, it is important to learn as much as possible about your options, risks, and the timing of your surgery to ensure that you get the best results. Here are the most important messages I want every woman to know when considering breast reconstruction surgery.

Start the conversation early.

If you think you’ll be interested in breast reconstruction surgery after your mastectomy, it’s important to start this conversation early. While your primary focus should be cancer care, you should also get opinions about breast reconstruction from both your physician (who will perform your mastectomy) and a board-certified plastic surgeon (who would perform your reconstructive surgeries) early in the process, so it can be included in your treatment plan.

This is because your goals, health status and cancer treatment protocol can affect the timing of your procedures: If you are deemed healthy enough and have early stage cancer, your physicians might recommend undergoing reconstruction surgery at the same time as your mastectomy to avoid multiple rounds of anesthesia and recovery. This will also lessen the shock and potential mental/emotional struggles associated with losing such a personal part of your body.

Know your options.

It’s worth mentioning that you do not have to undergo reconstruction. After the mental, emotional, and physical toll of cancer, you might decide that another surgery is simply not worth it, and choose to embrace the changes cancer made as you enter a new chapter of your life.

However, if you would like to replace one or both breasts after mastectomy surgery, it is important to know all the surgical options available to you. After a mastectomy, the only tissue remaining on the chest wall is muscle tissue and a thin layer of skin (nipple/areola is typically removed), the state of which might dictate the options available to you. It is important to note that breast reconstruction is typically performed in stages – usually over the course of two or more procedures.

Most commonly (in about 75-80% of cases), women opt to use saline- or silicone-filled implants to replace their breast tissue. However, you can also choose to undergo flap reconstruction, during which body tissue from other areas – such as the back, thighs, or buttocks – can be used to recreate breasts. In some situations the combination of both techniques may be needed. While flap reconstruction is a more complicated and invasive procedure, the results can feel more natural and last longer.

Symmetry is also a common concern: If only one breast is affected, it alone may be reconstructed. A breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.

Finally, the breast reconstruction involves reconstruction of the nipple/areola complex. Not all patients opt for that stage of reconstruction and those that do have a variety of options available (ranging from surgical procedures to 3D tattooing). Be sure to ask your surgeon about this if you are interested in nipple/areola reconstruction.

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Set reasonable expectations.

Advances in aesthetic medicine have made it possible to restore the appearance of breasts, but it’s important to know before undergoing reconstruction that reconstructed breasts will not look and feel exactly like they did before the mastectomy. Setting realistic expectations is an important step in having a satisfactory surgery experience.

In most cases, women experience no sensation in their reconstructed breasts. You should also be aware that visible incision lines (either from mastectomy or reconstruction) will always be present on the breasts, though these lines can fade over time with proper scar care.

While reconstructed breasts will never fully replace those you were born with, they can help you regain a sense of self and normalcy after breast cancer. My patients often describe the experience of breast reconstruction after a mastectomy as giving them a sense of feeling ‘whole again’.

Know that it can wait.

You might find peace in knowing that you don’t have to undergo breast reconstruction immediately after a mastectomy; in fact, there are several reasons you might want to wait. You might be emotionally and physically exhausted after cancer treatment, and want to wait until you’re in a better place before undergoing another procedure.

Cancer-related circumstances can also postpone your procedure. If you have an advanced disease that requires extended monitoring to ensure the cancer doesn’t return, you might wait until you are in the clear before proceeding with reconstruction. Radiation can also have a detrimental effect on reconstructed breasts, so if you’re still undergoing radiation post-mastectomy, you’ll want to wait until after your treatments are finished.

The good news is that age doesn’t seem to matter when it comes to reconstructive success. According to a comprehensive study conducted by the University of Michigan, older women who had breasts removed and reconstructed saw no greater risk of complications than younger women. This is promising, considering that 40 percent of the women who will be diagnosed with breast cancer this year are 62 and older.

Know your rights.

In October of 1998, Congress passed the Women’s Health and Cancer Rights Act, which requires group health plans and health insurers to cover the cost of reconstructive breast surgery, including all stages of reconstruction of the diseased breast, procedures to restore and achieve symmetry on the opposite breast, and the cost of prostheses and complications of mastectomy.

It’s your body.

There are many factors to consider when choosing whether to undergo breast reconstruction, including your mental, physical, and emotional state, as well as how reconstruction might impact your quality of life after cancer. Your goal, and your surgeon’s should be to restore your sense of confidence and normalcy. If you’d like to discuss your options, please schedule a consultation. I’d be happy to review your options with you, no matter where you are in your breast cancer journey.

W. Tomasz Majewski

Dr. Majewski is a board-certified plastic and reconstructive surgeon. He is the President and Medical Director of Majewski Plastic Surgery & Spa and Surgery Center at the Reserve in Jonesboro, AR. He has been serving Northeast Arkansas for over 18 years, and has been recognized as a top plastic surgeon by About You, Jonesboro Occasions, Jonesboro Radio Group, Premiere Magazine Jonesboro, and others.