Breast cancer, a malignant disease that mostly affects women, is related to an uncontrollable growth of cells in the breast caused by an acquired or inherited DNA mutation. While the reasons for the defects that cause breast cancer are not fully understood, a number of risk factors are known to contribute to its development. New cases of breast cancer affect an estimated 230,000 women and 2,300 men every year in the U.S., according to the American Cancer Society.

There are two types of treatments for breast cancer, local and systemic. Local treatments are meant to treat the cancer locally without affecting the rest of the body, and include surgery and radiation therapy, while systemic treatments, like chemotherapy, hormone therapy, targeted therapy, and bone-directed therapy, are focused on the use of drugs to reach cancer cells anywhere in the body. In the case of surgery, part or all of the breast is removed, which is why breast reconstruction is an important consideration in breast cancer treatment.

What Is Breast Reconstruction

Breast reconstruction is a surgical procedure for people who have had part of one, one breast, or both breasts removed due to a disease like cancer. During the surgery, the surgeon rebuilds the breast to match the size and shape of the other breast, and both the nipple and areola can also be reconstructed. “Most women who have had a breast removed (mastectomy) are able to have breast reconstruction. Women who have had only the part of the breast around the cancer removed (lumpectomy or breast-conserving surgery) might not need reconstruction, but sometimes they do. Breast reconstruction is done by a plastic surgeon,” says the American Cancer Society. There are numerous types of breast reconstruction surgery options, depending on a patient’s needs. “You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of both,” the Society says.

Options for types of breast implants include a silicone shell filled with cohesive gel or saline, and alternatives are currently under investigation. A tissue flap can also be used instead of implants. This is a section of the patient’s own skin, fat, or muscle from the stomach, back, thighs, or buttocks. Implant surgery can be done right after the removal of the breast, in a procedure called one-stage immediate breast reconstruction or direct-to-implant reconstruction. A two-stage reconstruction is the name given to a procedure using a short-term tissue expander, put into the breast after the mastectomy and gradually expanded to the desired size, to enable the skin flaps to stretch. This approach is used if the skin flaps are not thought healthy enough to support a full-size implant right away. In general, tissue flaps require more surgeries and longer recovery than implants, but can be more natural when they work well.

When and How to Have Breast Reconstruction

Most patients who have had an entire breast removed are eligible for breast reconstruction, even in cases of radical mastectomy or radiotherapy, and regardless of the size of a patient’s breasts. Usually, the patient’s health and age are not important considerations either. However, reconstruction may be discouraged for smokers, overweight patients, or patients who have diseases that increase the risks of a surgery. All of this should be part of a discussion between patients and their physicians. Patients may choose to have or not to have breast reconstruction surgery; it is a very personal decision.

Patients who decide to undergo the surgery may be placed on a waiting list due to the limited number of plastic surgeons experienced in the procedure. Another important decision is whether to have the reconstruction simultaneously with the breast cancer surgery (immediate reconstruction), or to do it later (delayed reconstruction). There are advantages and disadvantages to each option, and the decision also depends on the patient’s preferences. Physicians can, however, advise on the subject, taking into consideration the type and stage of the cancer, other treatments that may be needed, and the patient’s feelings and wishes. Again, patients should discuss breast reconstruction options with their physician before undergoing surgery to remove a tumor or breast.

Immediate vs. Delayed Breast Reconstruction

There are benefits and drawbacks associated with both immediate and delayed breast reconstruction. According to the Cancer Research UK, “an immediate reconstruction gives you a new breast straight away. The breast will be different to the one that was removed, but some women find that immediate reconstruction helps them cope more easily with their feelings about the loss of a breast.” However, the patient has no control over what is happening, the reconstruction may be damaged if radiation therapy is needed after the surgery, complications from the surgery could delay chemotherapy treatments, and the physician may discourage reconstruction if the breast tissue is not healthy enough.

“Some women prefer to get over the mastectomy and breast cancer treatment before they think about reconstruction. With delayed reconstruction you have more time to look at your options and discuss them with a specialist surgeon, your breast cancer treatment will be finished and won’t be affected by your reconstruction surgery, [but] you may have a larger scar on the reconstructed breast,” Cancer Research says. In addition, women may choose not to undergo reconstruction at all. Beyond personal preferences, reasons to consider in this decision include fear or health issues that prevent or complicate more surgeries, the need to quickly return to normal activities, concerns about losing muscle strength in the reconstruction, and costs should the surgery not be covered by insurance. Each decision is personal, and patients should take time to consider their options and discuss them carefully with their physician.

Note: Breast Cancer News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.