Should I Get Breast Reconstruction Surgery?

A woman who has surgery to treat breast cancer might also choose to have surgery to rebuild the shape and look of her breast. This is called breast reconstruction surgery.

If you are thinking about having this done, it is best to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before you have surgery to remove the tumor or breast. This lets the surgical teams plan the best treatment for you, even if you decide to wait and have reconstructive surgery later.

Reasons to have breast reconstruction

A woman might choose to have breast reconstruction for many reasons:

• To make her chest look balanced when she is wearing a bra or swimsuit
• To help make clothes fit better
• To permanently regain her breast shape
• So she won’t have to use a breast form that fits inside the bra (an external prosthesis)
• To feel better about her body

Breast reconstruction often leaves scars, but they usually fade over time. Newer techniques have also reduced the amount of scarring. When you’re wearing a bra, your breasts should be alike enough in size and shape to let you feel comfortable about how you look in most types of clothes.

After a lumpectomy or mastectomy, breast reconstruction can make you feel better about how you look and renew your self-confidence. But keep in mind that the reconstructed breast will not be a perfect match or substitute for your natural breast. If tissue from your tummy, back, thigh, or buttocks was used as part of the reconstruction, those areas will also look different after surgery. Before you make your decision, talk with your surgeon about scars and changes in shape or contour. Ask where they will be, and how they will look and feel after they heal.

Risks of breast reconstruction

Of course, it's important to consider the potential risks and side effects of breast reconstruction surgery as well. These are discussed in What to Expect After Breast Reconstruction Surgery.

Can reconstructed breasts hide cancer or make it come back?

Studies show that reconstruction does not make breast cancer come back. If the cancer does come back, reconstructed breasts should not cause problems finding the cancer or treating it.  

If you are thinking about having breast reconstruction, either with an implant or tissue flap (your own tissue), you need to know that reconstruction rarely hides a return of breast cancer. You should not consider this a big risk when deciding to have breast reconstruction.

Some important things to think about

• You might have a choice between having breast reconstruction at the same time as your breast cancer surgery (immediate reconstruction) or later (delayed reconstruction).
• Some women don’t want to make decisions about reconstruction while being treated for breast cancer. If this is the case, you might choose to wait until after your surgery to decide about delayed reconstruction.
• You might not want to have more surgery than is absolutely needed.
• Not all reconstructive surgery is a total success, and the result might not look the way you had hoped. It is important to discuss expectations with your plastic surgeon. 
• The cancer surgery and reconstruction surgery will leave scars on your breast and any areas where tissue was moved to create the new breast mound, such as the buttocks, tummy, thigh, or back areas.
• A rebuilt breast will not have the same feeling as the natural breast. Sometimes, it may have little or no feeling at all. The places the tissue to rebuild the breast was taken from (donor sites) might also lose some feeling. Over time, the skin might become more sensitive, but it won’t feel the same as it did before the surgery.
• You might have extra concerns if you tend to bleed or scar more than most people.
• Poor blood flow might cause some or all areas of the breast skin or flaps to die after reconstructive surgery. This death of the tissue is called necrosis. If it happens, healing is delayed and more surgery is often needed to fix the problem.
• Healing could be affected by previous surgery, chemotherapy, or radiation therapy. It can also be affected by smoking, diabetes, being obese, and other factors.
• Surgeons might suggest you wait to have reconstruction, especially if you smoke or have other health problems. It’s often recommended to quit smoking at least 2 months before reconstructive surgery to allow for better healing. You might not be able to have reconstruction at all if you are obese, actively smoke, or have blood circulation problems.
• The surgeon might suggest surgery to reshape your other breast to match the reconstructed breast. This is a called a symmetrizing procedure. This could include reducing or enlarging its size, or even surgically lifting the breast.
• If radiation will be part of a woman's treatment, the types of immediate reconstruction surgery she will be able to have might be limited. Certain types of reconstruction done before radiation can cause problems and lower the chances the rebuilt breast will look and feel as natural as possible, after the radiation is given.  You should discuss your best options with your plastic surgeon before surgery.
• Meeting with a plastic surgeon and knowing your reconstruction options before surgery can help you have more realistic expectations for the outcomes.

Help and support from someone who’s been there

It's important to know that there is advice and support out there to help you understand your reconstruction options as well as cope with the changes you’re going through if you have chosen reconstruction. Speaking with your doctor or other members of your health care team is often a good place to start. If you would like to talk with someone who has had your type of reconstruction, download the ACS CARES app. Through ACS CARES, you can match with a breast cancer survivor trained to support others facing breast cancer, as well as those who are thinking about having breast reconstruction. They can give you suggestions, reading material, and advice.