No doubt, if you plan to rebuild your breasts after surgery, you need to make some decisions. Here are some basic questions to consider.
“Should I or shouldn’t I?”
If you decide a mastectomy is the best cancer treatment choice for you, you have yet another decision to make: whether to have breast reconstruction. Some women are perfectly happy wearing an external breast prosthesis, while others choose breast reconstruction. Only you can decide what feels right for you; however, even if you are leaning against the surgery, experts recommend consulting a reconstructive plastic surgeon. (Your healthcare provider can recommend one.) That will give you a chance to discuss your options, learn more about this procedure, see photos of women who’ve had it done and weigh all the information you need to make a sound decision.
“Do I get it done now or later?”
You may undergo reconstruction at the time of your mastectomy or afterward. Here’s what to consider:
- Now: If you don’t need radiation, immediate reconstruction is preferable. The surgeon can save extra skin—possibly even your nipple—and the cosmetic result may be better. You’ll also be spared additional surgery, hospitalization and anesthesia.
- Later: If you need radiation, it’s better to hold off on permanent reconstruction because radiation can damage the new breast. An alternative is a tissue expander. This balloon-like device is used to stretch breast skin and chest wall muscles to make room for your permanent implant.
“Do I go for ‘real’ tissue or an implant?”
The next choice is whether to use a “flap” of fatty tissue from another part of your body, or to have an implant.
- Flaps: A breast is created using tissue from other parts of the body like the abdomen, back, buttocks or thighs, which is then transplanted to the chest by reconnecting the blood vessels to new ones in the chest. They tend to look and feel more like a natural breast than implants. But the surgery can be more complex, invasive and lengthen your hospital stay. You’ll also have scars and weakness in the area from which the tissue was taken.
- Implants: Made out of silicone or saline and inserted during or after a mastectomy, implants are put underneath the chest muscle. They may require less extensive surgery than flap reconstruction, but the results may look and feel less natural than flaps. In addition, implants don’t last a lifetime; you may need surgery to remove or replace them. Also, they can rupture or cause infection, pain or hardening of the tissues around the implant. Implants can make routine mammograms more difficult. And if you’re in your childbearing years, consider that breast-feeding may be impacted, either reducing or halting milk production.
“Saline or silicone?”
If you choose an implant, your options are saline or silicone gel.
- Saline—a silicone shell filled with saline, a sterile saltwater solution. Saline implants are inserted empty and filled when in place. They feel less natural than silicone implants.
- Silicone—a silicone shell pre-filled with silicone gel, a thick, sticky semi-solid substance. Silicone implants are better able to mimic the feel of a natural breast. Concerns about leaks have made these implants controversial, but the latest studies have found no link between silicone implants and medical problems.