Breast Reconstruction Program

Frequently Asked Questions

• What is breast reconstruction?

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  Breast reconstruction involves replacing breast tissue (lost during mastectomy or trauma or due to congenital defects) and creating a new breast form. This can be achieved by placing an implant under the skin and chest muscle or moving tissues from another part of the body to the chest area, or by combining these techniques. The aim is to match the remaining natural breast (symmetry) as closely as possible.

  Breast reconstruction usually requires a second minor procedure later to reconstruct a nipple and surrounding area (areola complex) and to optimize symmetry.

• Why do women consider breast reconstruction?

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  Each woman seeking breast reconstruction has her reason for it. Many feel comfort knowing that breast reconstruction is an available treatment option. Some women appreciate being able to return to a physical appearance similar to that before breast cancer surgery.

  Women describe a sense of emotional healing, restoration of self-confidence/femininity, joy and peace of mind after breast reconstruction. Some women choose breast reconstruction because they feel it allows them to return to as "normal" an appearance and lifestyle as possible. Some women find the mastectomy scar constantly reminds them of breast cancer. Other women prefer not to wear an external prosthesis (artificial breast) for a variety of reasons.

• Who can have breast reconstruction?

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  • Most women of any age who are in fairly good health and require a mastectomy.
  • Women at high risk for breast cancer who have their breasts removed as a preventative measure (prophylactic mastectomies)
  • Women with congenital defects

  Contradictions for breast reconstruction

  Women with severe lung disease, advanced diabetes, or those who have had a recent heart attack or are heavy smokers.

  Women who smoke are at risk for serious complications, affecting blood flow to the skin and underlying tissues. Women who smoke are also more prone to infection and delayed healing. Thus smokers considering this surgery are advised to discontinue smoking at least three months before and one month after the surgery.

  When cancer has spread beyond the breast region, women need to consider whether the pain and discomfort of breast reconstruction surgery will interfere with the quality of their perhaps shortened life.

  Women may not be suitable candidates for this surgery if their emotions, motivation or personal circumstances make it difficult for them to cope with additional surgery and healing.

• When can breast reconstruction be performed?

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  In the past, breast reconstruction was delayed for a period of time to allow women to recover both emotionally and physically after mastectomy surgery. Breast reconstruction is often done during mastectomy (immediate reconstruction). However, it can be done months or years after mastectomy (delayed reconstruction). Breast reconstruction must never interfere with the treatment of breast cancer.

  Ideally, women facing mastectomy should learn about their options for breast reconstruction from their general surgeons or medical oncologists before breast cancer surgery. Some doctors believe it is better to delay reconstruction when chemotherapy and radiation treatment are necessary after the surgery or when a patient is at high risk for wound healing complications (women who are smokers, diabetic, obese or have large breasts). Some women prefer to delay the reconstruction to allow them more time to consider their options.

  The woman should decide when to have breast reconstruction with advice from the team of medical specialists familiar with her case (family doctor, general surgeon, oncologist and plastic surgeon).

  Immediate reconstruction

  There are several advantages to immediate breast reconstruction. Some women wish to avoid the mastectomy scar and find that immediate reconstruction helps reduce the distress that often comes with losing a breast(s). During immediate reconstruction, the general surgeon, who removes the breast, and the plastic surgeon, who reconstructs the breast, work together to save breast skin (skin-sparing technique). This produces the best results. When less skin is removed during mastectomy, the scars are often easier to conceal. An additional benefit is that recovery from the mastectomy and breast reconstruction can happen simultaneously, without women needing to take additional time off work.

  Not all women are candidates for immediate reconstruction. Some women find that making the many decisions necessary for the treatment of breast cancer is enough to deal with at one time. Women undecided about reconstruction at the time of mastectomy might prefer to delay the surgery until they get used to living without a breast and have time to explore reconstruction surgery.

  Sometimes women who have immediate breast reconstruction compare the appearance and sensation of their natural breast with the reconstructed breast. This can lead them to feel less satisfied with their reconstructed breast than if they had lived without a breast before undergoing delayed reconstruction.

• Is breast reconstruction possible if I need radiotherapy and/or chemotherapy?

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  It is still possible for most women to have breast reconstruction before or after radiotherapy and/or chemotherapy. Breast reconstruction should be delayed between 3-4 weeks after chemotherapy and usually 4-6 weeks after radiotherapy.

  With tissue transfer reconstruction (moving muscle from the stomach or back to make a new breast mound), radiation therapy can be started before the surgery or once all wounds have healed in the chest area (usually 3-4 weeks)

  If tissue expander reconstruction (expander is put under the chest muscle to stretch the muscle so that an implant can be placed to make a breast mound) has been done and radiation is required, it is best the expansion process be done over a longer period of time to minimize risks. If it is known before the mastectomy that radiation treatment is needed, then tissue transfer reconstruction is advised, as complications after tissue expander followed by radiation tend to be high.

• What is the cost of breast reconstruction?

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  The Medical Services Plan (MSP) covers breast reconstruction, including the first and second-stage surgical procedures, hospital stay, and follow-up treatment for women with breast cancer. Balancing surgery on the opposite breast to match the size and shape of the breasts is also typically covered by MSP.

• What factors should be considered when deciding to have breast reconstruction?

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  Some women with a new breast cancer diagnosis find it difficult to sift through all the information they receive in the first few days. While it is important for them to be involved in the treatment decisions, they must also explore all options before making their decisions. Only then can they decide whether to choose immediate breast reconstruction.

  Appropriate management of breast cancer must be the most important factor for them to consider. Women have a right to be informed about all possible choices, including breast reconstruction, as part of breast cancer management. General.
  
  surgeons or family doctors provide women with a referral to a plastic surgeon.

  The plastic surgeon with expertise in this type of surgery must be involved in the information and decision-making process. 
  
  Women should ask plastic surgeons about their experience with breast reconstruction, what options he/she thinks are appropriate for the case, and how comfortable the plastic surgeon feels with the option chosen.

• How many surgeries are required for breast reconstruction?

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  Breast reconstruction occurs in stages. Two surgeries (with general anesthetics) are usually needed for immediate tissue transfer reconstruction. The first stage covers both the mastectomy and tissue expander placement. If the natural breast needs to be enlarged, reduced or uplifted to match the reconstructed breast, that surgery is most commonly done at the same time as the mastectomy and reconstruction.

  The second stage to create the nipple is done about 4 to 6 months after the breast reconstruction. Tattooing around the nipple to create the areola is done when the nipple has healed. Nipple reconstruction and tattooing are optional. However, at this stage, women can have their breast symmetry and donor site improved if required.

  For delayed tissue transfer reconstruction, three surgeries are needed.

  The first stage is mastectomy. The second stage is breast mound reconstruction which often includes surgery to balance the size or shape of the opposite breast(s). The third stage is to create a nipple and areola, which is optional but highly recommended to give the best outcome.

  For immediate tissue expander and implant surgery, the first stage occurs when the tissue expander is placed at the time of mastectomy. The second stage occurs after the expansion process is complete. Second-stage surgery involves removing the expander and placing an implant.

  For delayed tissue expander and implant surgery, five stages are required. The first stage is mastectomy surgery, the second stage is the expander placement, the third stage is the tissue expander removal, and implant placement, the fourth nipple reconstruction, and the fifth is tattooing.

  With all types of reconstruction, complications may require additional surgery. The need for further surgery beyond the initial reconstructive procedures is usually higher in implant reconstruction cases.

• What questions should I ask the plastic surgeon?

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  Patients benefit from talking with family, close friends, other women who have gone through this experience and women with breast cancer who have chosen not to have breast reconstruction. Women should ask their plastic surgeons for the names and telephone numbers of patients who volunteer as a resource for women making decisions about breast reconstruction. All this provides valuable input toward an informed decision. However, the ultimate decision regarding breast reconstruction should be the patient.

  Sample list of questions: 

  • What type of breast reconstruction would you recommend for me?
  • Why do you recommend this type of breast reconstruction?
  • How many of these types of (tissue transfer or implant placement) breast reconstruction surgeries have you done in the last year?
  • When and where can I have the surgery?
  • What does the reconstructed breast look like immediately after the surgery, a few months later and after one year?
  • Can you show me before and after photographs of the surgery you have done?
  • What does the reconstructed breast feel like in relation to the normal breast?
  • Will the two breasts match?
  • What are the complications, risks and benefits?
  • How long is the hospital stay?
  • How long will recovery be before a return to work or normal activities?
  • What is needed to ensure a good recovery?
  • Could a reconstructed breast hide a new cancer?
  • May I talk to one of your patients who has had this surgery?