More and more women with breast cancer are choosing surgery that removes less breast tissue than a mastectomy (removal of the entire breast). This is called breast conservation surgery (lumpectomy or segmental mastectomy). However, some women choose mastectomy. Some of those who choose mastectomy also choose to have reconstructive surgery to restore the breast’s appearance.

If you are thinking about having reconstructive surgery, it is a good idea to discuss it with your surgeon and a plastic surgeon experienced in breast reconstruction before the mastectomy. This allows the surgical teams to plan the treatment that is best for you, even if you decide to have reconstructive surgery later.

Breast reconstruction is a surgical procedure to restore the appearance of a breast for women who have had a breast removed (mastectomy) to treat breast cancer. The surgery rebuilds the breast contour and, if you desire, the nipple and areola (the darker area surrounding the nipple).

Most women who have had a mastectomy can have reconstruction. Women who have had lumpectomy usually do not need reconstruction. Breast reconstruction is done by a plastic surgeon.
This information is designed to give you the facts you need to make an informed decision about breast reconstruction. The decision to have breast reconstruction is a matter of individual choice. No single source of information can provide every fact or give you all the answers. You and those close to you should discuss any questions and concerns about reconstructive surgery with your doctor.

Special Considerations in Breast Reconstruction
Several types of operations can be used to reconstruct your breast. You can have a newly shaped breast with the use of a breast implant, your own tissue flap, or a combination of the two. A tissue flap is a section of skin, fat, and muscle, which is moved from your tummy, back, or other area of your body to the chest area.
Immediate or Delayed Reconstruction
Immediate reconstruction is reconstructive surgery that is done at the same time as the mastectomy when the entire breast is removed. A plus with immediate reconstruction is that the chest tissues are undamaged by radiation therapy or scarring. Also, immediate reconstruction means one less surgery. Delayed reconstruction is reconstructive surgery that is done at a later time. For some women, this may be advised if radiation is to follow mastectomy. This is because radiation therapy that follows breast reconstruction can increase complications after surgery.

Decisions about reconstructive surgery will depend on many personal factors such as:

• Your overall health
• Stage of your breast cancer
• Size of your natural breast
• Amount of tissue available (for example, very thin women may not have the excess body tissue to make flap grafts possible)
• Your desire to match the appearance of the opposite breast
• Your desire for bilateral reconstructive surgery and your insurance coverage for the unaffected breast and related costs
• Type of procedure
• Size of implant or reconstructed breast

Goals of Reconstruction

Women choose breast reconstruction for different reasons.
The goals of reconstruction are:

To make your breasts look balanced when you are wearing a bra
To permanently regain your breast contour
To give the convenience of not needing an external prosthesis

The difference between the reconstructed breast and the remaining breast can be seen when you are nude. However, the breasts in a bra will hopefully be close enough to one another in size and shape so you feel comfortable about how you look in most types of clothing. Your body image and self-esteem may improve after your reconstruction surgery, but this is not always the case. Breast reconstruction does not fix things you were unhappy about before your surgery. You may be disappointed with how your breast looks after surgery. You and those close to you must be realistic about what to expect from reconstruction.

Restoring the breast during surgery, rather that after, goes a long way toward restoring self-confidence.