Breast Reconstruction After Breast Cancer

After breast cancer treatment, some women choose breast reconstruction to help restore the shape, size and balance of their breasts. Reconstruction can be an option after a mastectomy (removal of the entire breast) or a lumpectomy (removal of the cancer while preserving most of the breast). 

For some patients, reconstruction begins at the time of breast surgery, while others choose to wait until a later date.

Breast reconstruction falls into two categories:

• Implant reconstruction: This surgery relies on breast implants to help form a new breast mound.
• Flap (or autologous) reconstruction: This surgery uses your own tissue from another part of your body to form the breast. Breast reconstruction surgeries happen in stages. It often takes multiple surgeries to create and shape the breast mound.

Factors that shape your treatment plan

Your healthcare team will help you choose the best treatment plan. Here are some important factors to consider:

• Body type
• BMI < 40
• Cancer surgery (lumpectomy, skin-sparing or nipple-sparing mastectomy, unilateral or bilateral)
• Cancer treatments (chemotherapy, immunotherapy or radiation)
• Health status, if diabetic, A1C < 7%
• Medicines
• Quitting smoking and nicotine use
• Time required for surgery and recovery
• Tissue availability

Determining your breast reconstruction goals

Breast reconstruction is very personal. Not every woman chooses to have breast reconstruction. It may be a good option if you:

• Are able to cope with your diagnosis and treatment
• Have a positive outlook
• Set realistic goals for restoring your breasts and body image
• Do not have other health issues that could slow your healing

It is important to learn everything you can about breast reconstruction. Friends, family, social media and support groups can be a big help. But other people’s experiences may not match your treatment plan and situation. For the best answers, talk with your healthcare team.

It is normal to be worried or uncertain about reconstruction. Many women feel overwhelmed. Please share your feelings with your healthcare team so we can support you.

Tissue expanders (temporary implants)

Tissue expanders are a temporary implant device placed during or after mastectomy. They are placed under the skin to form a pocket to help build back the breast mound. A product called acellular dermal matrix (ADM) is often placed around the expander for support.

The expander lets your team stretch your skin slowly and safely.

It can be placed above or below the chest muscle, depending on what you and your plastic surgeon decide. The surgery to place it usually takes about two hours.

Two to three weeks after placement, a small needle is used to inject small amounts of saline into the expander port. The time it takes to complete expansion depends on your size, expander size, breast shape and your cancer treatments.

After expansion, the expander will be replaced with a permanent implant in a second surgery. This surgery usually lasts one to three hours and does not require a hospital stay.

Sometimes a small breast implant can be placed during a mastectomy procedure. This is called “direct to implant.” The skin after surgery is delicate, so slow tissue expansion is safer for some patients.

Breast implants

You and your plastic surgeon will decide the best implant for you. The shape and size of your implant can change how it looks and feels.

Our surgeons often use smooth, silicone implants for reconstruction. Silicone implants are very durable, feel more like breast tissue and work well for most patients.

Flap reconstruction uses your own skin, fat and sometimes muscle to create a breast mound. This is a good choice for patients who do not want implants. It is also useful for patients who need radiation, since it adds healthy tissue taken from another place on the body. 

Flap reconstruction is a highly sophisticated microsurgery. Surgeons use a microscope to carefully connect tiny blood vessels from your own tissue (usually from your stomach) to your chest to create a living, natural breast. Because it's complex, the surgery can take several hours and usually requires a short hospital stay.

If you are interested in breast reconstruction, your journey typically begins with a referral from the Comprehensive Breast Care Center at the UK Markey Cancer Center or another healthcare provider.

Once we receive your referral information, a member of our team will contact you to schedule a consultation. During your first visit, you will meet with our breast reconstruction coordinator, a nurse practitioner who will help guide you through the process and answer your questions.

At this appointment, we will review your medical history, discuss your cancer treatment and perform a physical exam. We will talk with you about your goals and explain the reconstruction options that may be right for you based on your individual needs and treatment plan.

Our team will provide detailed information about your options so you can make informed decisions about your care. We encourage you to ask questions and share any concerns along the way.

As part of your evaluation, we will take photos of your chest and, in some cases, your abdomen. These images help us track your progress and compare your results throughout the reconstruction process.

Breast implants approved by the U.S. Food and Drug Administration (FDA) are carefully tested to make sure they are safe and work well. Many people with breast implants have no serious problems.

To check for hidden issues in silicone implants, the FDA recommends an ultrasound or MRI beginning five to six years after placement and every two to three years after that. Routine implant replacement is no longer needed.

Radiation therapy can make the reconstructed breast change shape or shrink. The skin on the breast may feel thicker, harder or less elastic. This side effect is called radiation fibrosis.

Sometimes the skin may look darker or more red. The skin may show signs of broken blood vessels or spider veins. The skin changes can happen many months or years after radiation. An implant can become hard or painful (capsular contracture) or lose its shape after radiation. The implant may need another surgery to fix this. 

In most cases, going from a tissue expander to a permanent implant is postponed for at least six months after the last radiation treatment. Other reconstruction efforts, such as tissue-based reconstruction, are also deferred until at least six months post radiation.

After creating the breast mound, patients may want more surgeries to improve the shape or balance of the breasts. These surgeries can include grafting fat, changing implants, lifting or reducing the breast, or fixing scars. If only one breast is affected, surgery may be done on the other breast to make them more even.

Some patients choose to have a nipple created or to get a 3-D nipple tattoo. Your team will help you decide the choice that is right for you.

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law passed in 1998. The act protects you if you choose to have breast reconstruction after mastectomy. Under the act, group healthcare plans offering mastectomy coverage must also provide coverage for some services relating to mastectomy.

The following services are covered:

• All reconstruction of the breast with the mastectomy
• Surgery and reconstruction of the other breast for symmetry
• Prostheses
• Treatment of physical complications of the mastectomy, including lymphedema

If you have concerns about insurance coverage, contact your insurance company to discuss full benefits and coverage details.

To refer a patient, submit your order for “Breast Reconstruction" through UK HealthCare EpicCare Link or call UK•MDs at 800-888-5533.