Breast reconstruction after cancer

Matthew Chetta, MD

Plastic Surgery

For many who have undergone a mastectomy after a diagnosis of breast cancer, the change in their appearance after losing one or both breasts can be difficult and cause feelings of anxiety, depression and a sense that they’ve ‘lost’ the person they knew themselves to be. Breast reconstruction surgery can return your appearance to one you find more familiar, but you may be wondering whether it’s the right choice for you.

Plastic surgeon Matthew Chetta, MD, spoke with us about breast reconstruction surgery, including the pros and cons, what recovery from breast reconstruction is like and more.

What are the reconstructive options after a mastectomy?

“For total breast reconstruction, patients have options. Some will choose implants, while others will opt for autologous reconstruction, or reconstruction using their own tissue,” said Dr. Chetta.

There are nuances to each approach, but they both are great options depending on the patient, their desire, and the clinical picture.

What are the pros and cons of breast implants?

“Implants are great for patients who either want a simpler surgery, or those who don’t have enough tissue to use for a total reconstruction,” said Dr. Chetta.

The process of implant-based reconstruction generally has two stages. The first step involves placing a temporary tissue expander (called a spacer) during the mastectomy, which is expanded over time until it reaches the desired volume. Once you reach your desired volume, a second surgery exchanges the tissue expander for the implant.

What does flap reconstructive surgery involve?

“Flap surgery is usually much more involved, requiring special knowledge and expertise in microsurgery and specialty equipment that is available at institutions that specialize in this procedure,” said Dr. Chetta.

The most common form of reconstruction would be the DIEP (Deep Inferior Epigastric Perforator) flap, which is tissue harvested from the abdomen and transferred to the breast. This procedure requires taking this tissue and reconnecting the blood supply with the assistance of an operating microscope.

What are the pros and cons of flap reconstructive surgery?

“The benefits of this type of surgery are that it uses the patient’s own tissue, which some may feel more comfortable with. There are no implants involved and it’s a better option particularly if the patient has a history of radiation,” said Dr. Chetta.

The downsides to flap reconstructive surgery include a longer hospital stay, a larger and more complex surgery and a second surgical site due to taking the tissue from the abdomen.

Who is a candidate for reconstructive surgery?

“Nearly every patient is a candidate for breast reconstruction if one desires,” said Dr. Chetta. “Some patients will decide not to go through the reconstruction process and will instead ‘go flat.’ Your decision is entirely up to you, and each patient’s journey is their own experience.”

Dr. Chetta noted that every option, whether you choose flap surgery, decide to receive implants or decide against reconstruction entirely, are acceptable decisions and should be based around your comfort level and discussions with your health care team about which option is best for you.

When is the best time for breast reconstruction?

“Breast reconstruction is an option for the life of the patient,” said Dr. Chetta. “There isn’t a hard and fast timetable. There are valid reasons for delaying reconstruction, but most women who elect to undergo reconstruction prefer to start at the time of their mastectomy, or as close to it as they can.”

Others may decide to wait before they make a decision, in order to speak with others who have undergone reconstruction, have more involved discussions with survivorship teams or simply to take some time to breathe without the pressure of more surgical recovery.

When should you meet with a plastic surgeon if you’re considering reconstructive surgery?

“Patients should meet with a plastic surgeon as early in the process as possible,” said Dr. Chetta. “There are many details to discuss and knowing the information as early as possible in the process will help develop a plan for optimal results.”

What does the recovery involve and what support is needed?

“The recovery process is different depending on which method of reconstruction one undergoes,” said Dr. Chetta. “Generally speaking, it’s similar to recovering from any other surgery as far as taking time to rest and having a support person nearby to help you with basic functions during the early days and as needed.”

For implant-based reconstruction, most surgeons will recommend a recovery phase that lasts about four weeks. For those who undergo flap reconstruction, recovery will take around six to eight weeks due to the more complicated surgery.