Breast reconstruction

Breast reconstruction is surgery to make the breast look and feel as natural as possible after all or part of it has been removed. It is done by a plastic surgeon who is specially trained to do this surgery. It may require more than one operation. You may also have surgery on the breast that didn’t have cancer to make both breasts look as alike as possible.

The decision to have breast reconstruction is a very personal one. You may choose to have reconstruction if you think that it will make you feel more comfortable, confident and like yourself. You may also be interested in reconstruction if you don’t want to use an external breast prosthesis.

Before you decide to have breast reconstruction, talk to your plastic surgeon about what you hope for from the surgery.

A reconstructed breast will not look exactly like a natural breast, but the surgeon will try to make it look as much like the breast that was removed as possible. It's also important to know that the reconstructed breast will never feel exactly like a natural breast, in terms of sensation and firmness. The reconstructed breast will not have sensation like a natural breast and will feel numb. This is because the nerves that runs through the breast are removed during a mastectomy. Over time, the skin on the reconstructed breast may regain some sensation. The reconstructed breast may be softer or firmer than your natural breast, depending on the type of reconstruction you have.

Your plastic surgeon will talk to you about the different types of breast reconstruction and which one will work best for you. They will consider the following factors when they decide which types of breast reconstruction to offer you:

• your overall heath and any health problems you have
• if you have had one or both breasts removed
• the health of the tissue where the reconstruction will be done
• if you had (or will have) radiation therapy for breast cancer
• if you had (or will have) chemotherapy for breast cancer
• how much tissue was removed during surgery for breast cancer
• the amount of muscle and fat in the abdomen, thigh, back or buttock that can be used for reconstruction
• the shape and size of both breasts or the opposite (unaffected) breast
• your personal preferences

Find out more about different types of breast reconstruction.

The timing of breast reconstruction may depend on which treatments you need to have for breast cancer and when you feel ready to have this surgery.

Immediate reconstruction is done at the same time as surgery to remove part or all of the breast.

Delayed reconstruction is done as a separate surgery after other cancer treatments, including chemotherapy and radiation therapy, are finished. If your surgeon recommends you have delayed reconstruction, it may be done 6 to 12 months after a mastectomy or breast-conserving surgery. Delayed reconstruction can also be done years after breast cancer treatment. It may require more than one operation.

Immediate-delayed reconstruction is a combination of the above options. During surgery to remove part or all of the breast, the surgeon places a tissue expander in the place of where the breast will be reconstructed. Another surgery is done to complete the breast reconstruction after other cancer treatments are finished.

Your surgeon will recommend the best timing of breast reconstruction based on your treatment plan. You may not be offered immediate reconstruction if you still need chemotherapy and radiation therapy. This is because these treatments could damage the reconstructed breast and increase the risk for complications after surgery, such as problems healing and infections.

The timing of breast reconstruction also depends on your preferences. You may not be ready for more surgery, not want to face risks that come with surgery or feel unsure if you want reconstruction at all. So you may choose to remain flat or try a breast prosthesis before deciding to have breast reconstruction. If you don't want reconstruction as soon as your cancer treatments have finished, talk to your surgeon about delaying reconstruction until the time is right for you.

You will need some follow-up care after breast reconstruction to check for any complications or problems from the surgery. Your plastic surgeon or healthcare team will work with you to decide on follow-up care to meet your needs.

Depending on the type of breast reconstruction, you may have follow-up visits each week or month during the first year. As time goes on and your body heals, you will need to have follow-up visits less often. Once you've finished these initial follow-up visits and if you don't have any complications, you may need to just have a yearly physical exam. If you have breast reconstruction using implants or tissue from other parts of your body (called autologous breast reconstruction), you do not need to have regular mammography done on the reconstructed breast. But you will need to have regular mammography on the natural breast.

You should also know what is normal for both your natural and reconstructed breast. Keep in mind that it may take several months for tissue to heal and become soft after breast reconstruction. You may have scars, which will fade over time but might never go away completely.

Your surgeon will show you how to check your reconstructed breast and explain what changes to look for and when to seek attention. It is very important to report changes you find to your healthcare team. These may include fluid leaking from the breast, swelling and new skin changes. Also tell your healthcare team about any new symptoms or if you have pain.

Talk to your surgeon about when you can return to your normal activities and the type of exercise you can do. You can start to wear a bra when the incision has completely healed.

Breast reconstruction after breast cancer surgery is covered by most provincial and territorial health insurance plans. The amount and type of coverage vary across Canada. Check your provincial or territorial health insurance plan before having breast reconstruction.