Breast Reconstruction: What To Think About Before Deciding

Many people with breast cancer will have some type of surgery as part of their treatment. If your doctor recommends surgery (breast-conserving surgery or a mastectomy) to remove the cancer, it's normal to worry about the physical changes and how it will impact the way you view your body. Breast reconstruction surgery can rebuild the shape and look of your breast after surgical treatment.

Deciding whether to have breast reconstruction surgery can be physically and emotionally overwhelming.

Here are a few tips and resources to help you consider what is best for you.

• Talk about it.
• Understand types of reconstruction surgery.
• Decide what's important to you.
• Take everything one step at a time.

Remember: You have a team of healthcare professionals, caregivers, loved ones, and peers who can support you. Choosing to have breast reconstruction surgery is a very personal decision. As difficult as it is, this is your experience. Learn to speak up for yourself. Become comfortable asking friends and family for help when you need it, especially because they likely want to do whatever they can to help you.

Healthcare Team Conversations

Have honest conversations with your care team. Your doctor may suggest immediate reconstruction or delayed breast reconstruction surgery based on your health, your treatment needs, and the type of tumor you have. Some women choose to delay reconstruction to have more recovery time after breast surgery and research their reconstruction options.

When talking with your care team, express any concerns you have about reconstruction surgery (immediate or delayed) and ask about your alternative options. Alternatives to reconstruction include choosing not to replace the removed breast (going flat) or using a breast form, an artificial body part (prosthesis) that can be worn inside a bra.

Typically, choosing to go flat does not cause issues for people who have had both breasts removed. For people who have one breast removed, going flat may lead to issues with posture, balancing, and back pain. Again, these are factors to consider and discuss with your care team. 

Tip: Don't be afraid to talk to your healthcare team about any questions or worries you have, but also remember that this is your body and your decision. If you feel rushed or don’t think you are being heard, seek a second or even third opinion.

Emotional & Mental Health Support Conversations

Breast cancer surgery of any kind, including reconstruction, can be difficult physically and emotionally. Finding support can help you cope with feelings of loss, grief, and change after your procedure. There are many places to turn for practical and emotional support. 

Check with your healthcare facility to see if they can connect you to a patient or nurse navigator or oncology social worker. These team members can help you cope with any physical changes and side effects long after surgery.

Attending a cancer support group, virtually or in person, can also be an effective way to cope. Support groups offer a place where you can talk about what you are experiencing with others who are going through similar experiences. You might also learn about coping strategies that have helped other group participants. In these ways, connecting with others who understand can improve your ability to cope and provide a sense of security and well-being.

There are 2 main types of breast reconstruction surgery:

1. implant reconstruction – This procedure uses a breast implant (either saline implant or silicone-gel filled) to help restore the shape of the removed breast. Very few people are able to have breast implant reconstruction performed in one stage. Breast implants, whether saline or silicone, may need to be replaced with surgery at some point in your lifetime.
2. tissue flap – A tissue flap procedure (also called an autologous reconstruction) rebuilds the breast using tissue from your body. The tissue may be removed from your abdomen, back, thighs, or buttocks. Typically, tissue flap reconstructions require more surgery than implant reconstruction. Tissue flaps also have a longer recovery period.

With either procedure, your surgeon should talk with you about potential side effects and concerns. Also be sure to ask your doctor about methods to help prevent future risks. 

As you consider whether breast reconstruction may be right for you, think about factors such as:

1. Your feelings and emotions – How will the loss of a breast affect the way you view your body or sexual identity?
2. Potential scarring – Will scars beyond the breast bother you?
3. Recovery process – How will your lifestyle be affected as you recover?
4. Future surgery – It's possible that reconstruction surgery may be needed in the future to correct for physical changes.

As you think about what's important to you, remember that it’s OK if you choose not to undergo reconstruction. Many people who decide not to have reconstruction embrace this decision and feel empowered about their body and their choice. 

Creating a new normal around your cancer diagnosis and life post-surgery will help you feel like you have more control over your situation. Try to relax as much as possible, surround yourself with a support team, and seek out resources that can help you.