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Should I have reconstruction after my mastectomy?

Oct 19, 2021

St. Joseph’s/Candler Breast Surgeon Dr. Susan Mahany discusses pros, cons of breast reconstruction surgery and why some women are choosing prosthesis or to go without

Being told you have breast cancer can be emotionally draining. Deciding on a mastectomy to remove either one or both your breasts can take even more of a toll on you.

“People need to keep in mind there’s an emotional component to waking up with a flat chest,” says Dr. Susan Mahany, breast surgeon and medical director of Telfair Breast Surgery at St. Joseph’s/Candler. “Some women want to wake up with something there. Then there are others who are fine with delayed reconstruction or some are fine without any reconstruction. It’s a very personal choice.”

St. Joseph's/Candler Breast Surgeon Dr. Susan Mahany

It’s important to know that your healthcare team will help you make the best treatment decisions. It’s also important to know that every woman and every cancer is different.

First, your doctor may not feel a mastectomy is necessary. A mastectomy is a surgical procedure that removes the entire breast – either unilateral (just one) or bilateral (both).  There’s also the option of lumpectomy, which removes the tumor and cancerous tissue inside the breast while leaving the remaining breast tissue.

Related Article: Understanding breast cancer treatment options

There is no difference in survival for a mastectomy versus a lumpectomy in most patients, Dr. Mahany says. But, there are some women, depending on their age, type of cancer or personal choice, who will get a mastectomy.

Breast reconstruction

If you are getting a mastectomy, your surgeon will talk to you about breast reconstruction. Theoretically, Dr. Mahany says, every patient could be offered immediate reconstruction. But honestly and effectively, immediate reconstruction is not for everyone.

Breast reconstruction is surgery to create a new breast shape in the place of the removed breast. It can be done with implants and/or with tissue from another part of your body. The goal of the plastic surgeon is for the breast mound created to come as close as possible to the shape and natural look of your breast. This may need to be done in stages, depending on your type of surgery and size of your breasts.

Immediate reconstruction means the surgery takes place directly following the mastectomy. There are benefits to this: one hospitalization, one anesthetic and one recovery time. But it also comes with risks, meaning not everyone is a candidate for immediate reconstruction.

For example, age is considered. An elderly patient most likely will not be referred for reconstruction because it’s a long operation, Dr. Mahany says. The length of mastectomy can take anywhere from an hour to an hour and a half and then that would be followed by reconstruction taking up to another four hours.

Your type of cancer also plays a role in that decision. If you have inflammatory breast cancer, for example, most of those patients will need radiation treatment following surgery. If you were to have immediate reconstruction, there’s a risk of developing a wound complication. If that were to occur, then that would delay treatment. Patients with cancer in the lymph nodes will most likely need radiation treatment.

“The problem with doing immediate reconstruction on those patients is, if they have a wound complication, then you end up delaying the treatment for the cancer, and you don’t want to do that,” Dr. Mahany says. “For a lot of those patients we will discuss delayed reconstruction.”

Other factors may play a role in delaying reconstruction, such as if the patient has diabetes or is morbidly obese, because they are additionally at higher risk of developing wound complications.

Delayed reconstruction

If you choose to delay reconstruction, there are some options. One is your surgeon could perform a skin sparing mastectomy that leaves plenty of skin so when it’s time for reconstruction, the plastic surgeon can use that extra skin.

Or, during your surgery, the plastic surgeon can put in a tissue expander that can be radiated through if radiation treatment is required. When it’s time for reconstruction, the plastic surgeon takes the expander out and inserts an implant.

“It’s a very tough decision. Nothing is cut and dried,” Dr. Mahany says. “But we have to be the ones that guide them and give them the information.”

Prosthetics and the Transformation Station

If you choose not to do any type of reconstruction, but still want to have the appearance of breasts, prosthetics may be a good option for you. At the Nancy N. and J.C. Lewis Cancer & Research Pavilion, we have an area dedicated to helping patients with prosthesis called the Transformation Station. We also have a certified mastectomy fitter, Jane Kilen.

During the post-mastectomy fitting process, the certified fitter will measure and evaluate the surgical area for pressure marks, scaring and sensitivity. The patient and fitter will discuss all appropriate treatment options including styles, shapes and materials, as well as the patient’s goals and expectations. Instructions on use and care of the items also will be provided during the fitting.

The post-mastectomy bra looks and feels like a traditional bra, but has several special characteristics that are unique and specific for use after a mastectomy, such as the integral pocket that holds the external breast prosthesis in place. The Transformation Station has a variety of post-mastectomy bras of all sizes and colors.

We also offer post-surgery bras with front and back closures and post-surgery camisoles.

“Transformation Station believes that quality of life is critical for physical and emotional wellness,” says Kilen. “We exist to support the healing process after surgery by fitting quality garments, wigs and medical supplies designed to complement their physician’s treatment and also enhance the beauty and comfort of the individual.”

Related Article: Transformation Station at the LCRP helps female cancer patients find their fit

“Most of the women that I know that have had mastectomies are perfectly happy with their prosthesis, and then there are some that decide not to even wear them,” Dr. Mahany says.

“From the beginning, we have to look at the whole picture,” she says. “Everybody could theoretically be offered reconstruction, but there are cases when we say we want to wait on a delayed reconstruction or look at our other options.”

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