General Considerations

Breast Reconstruction is Optional

In general, breast reconstruction is an elective process. Some women will decide to only undergo mastectomy without reconstruction. Other women will decide to have their reconstruction performed at a later time. For most women, multiple options will exist for reconstruction. Because of all the decisions that need to be made (sometimes in a short amount of time), it is very important that the patient have a good relationship with her Surgical Oncologist and Plastic Surgeon so she can be well informed about her choices and make the decision that is best for her.

Symmetry

In general, no woman has two breasts that are exactly the same. We all have small amounts of asymmetry in our bodies, and that is also true in breast reconstruction. Although it can never be guaranteed that a woman will be “symmetric” after undergoing the breast reconstruction process, a reasonable goal is to bring any asymmetries to a level that is acceptable for both the patient and the Plastic Surgeon. Our general goal is to maximize the functional and cosmetic outcome of the patient.

GOALS

The main goal of breast reconstruction is to allow a woman to wear clothing that fits well and evenly without the use of an external prosthesis. The presence or absence of visible scars will depend on the type of mastectomy the woman has and what type of reconstruction is performed. In general, most scars are concealed below even low cut outfits and a majority of women can wear swimming suits without scars being evident.

The secondary goal of breast reconstruction is to have the woman look as good naked as possible. To do this, nipple reconstruction and tattooing should be considered, and frequently surgery to the other (non-cancer) breast might be considered to lift the breast to allow for better symmetry. Some women will decide to go through all stages, including nipple and tattooing, while others might want only the breast mound created. These decisions are made after thoughtful discussions with the Plastic Surgeon.

Timing of Reconstruction

Immediate Reconstruction- DIEP Flap

‘Immediate’ reconstruction is when the breast reconstruction occurs at the same time as the mastectomy. One major benefit of immediate reconstruction is being able to wake up from anesthesia with a breast reconstruction and not having to live with a mastectomy. There is also opportunity for a potentially better cosmetic outcome by being able to utilize skin-sparing mastectomy scars. Frequently, if only one breast is undergoing mastectomy and reconstruction, the other breast can be lifted and shaped to provide good symmetry.

Delayed Reconstruction- DIEP Flap

‘‘Delayed’ reconstruction is when the reconstruction is performed at another time after the mastectomy and other treatments have been completed. Mastectomy without reconstruction is frequently performed when the woman has an advanced cancer, requires radiation therapy, has other medical issues, or has not been previously counselled about breast reconstruction. Although the scar pattern after delayed breast reconstruction is usually not as ideal as with an immediate reconstruction, the shape and appearance in clothing should be excellent.

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