1. Can I have breast reconstruction?
All women who are going to have (or have had) a mastectomy can be considered for breast reconstruction. In most cases, if you are in overall good health, you will have options to choose from. If you have other significant medical issues that would make additional surgery dangerous or result in a poor outcome, your surgeon may not recommend breast reconstruction.
2. Can I have breast reconstruction at the same time as my mastectomy?
This is called “immediate reconstruction” and some women may be candidates. Immediate reconstruction is often considered for prophylactic mastectomies or in cases where no radiation therapy is anticipated.
The alternative is called "delayed reconstruction" and usually takes place six to 12 months after your mastectomy. There is no time limit for delayed reconstruction. Your reconstruction can be done as early as several months after your mastectomy or many years later. Working together, your general surgeon and plastic surgeon will advise you on whether immediate or delayed reconstruction is best for you.
3. Is there a cost for breast reconstruction?
Breast reconstruction is recognized by the Ontario Health Insurance Plan (OHIP) as an important part of breast cancer treatment. As such, OHIP covers virtually all aspects of your breast reconstruction including the costs of surgery, breast implants, hospital stay (if necessary), nipple areolar reconstruction and most balancing surgeries on the opposite breast if needed.
4. When can I return to work or my normal activities after surgery?
This will vary significantly between patients and between types of reconstruction. In general, you can aim to return to most activities after two–four weeks for implant-based reconstruction or six–eight weeks for procedures using your own tissues. Remember, recovering from surgery is a gradual process and your health care team will be there to help you.
5. Are breast implants safe?
All breast implants used in breast reconstruction are approved by Health Canada and have a long track record of safety and proven results. Silicone implants are the preferred choice for breast reconstruction but all implants have risks associated with them. Implants may need to be replaced in the future due to a number of possible reasons, including: hardening of the scar tissue around the implant (capsular contracture), shifting of the implant from its intended position, or failure of the implant itself (implant rupture). None of these conditions are dangerous but may require additional surgery to correct them.
6. What common side effects follow breast reconstruction?
The types of side effects patients face following breast reconstruction depends on the type of reconstruction performed. Shortly after surgery patients may have issues related to pain and recovery from surgery. Delayed (slow) healing can occasionally occur and asymmetries (differences between the two breasts) sometimes require additional surgery to correct.
Your plastic surgeon will discuss potential long-term side effects with you in detail. You should understand the possible complications of implants (see question #5) and the complications from using your own tissues (the most common of which is weakness in the donor area). All surgery results in scarring and your plastic surgeon will advise you on how to best manage your scar.
7. What will my reconstructed breast feel like?
A reconstructed breast has different feeling or sensation than a natural breast. Regardless of the type of reconstruction, a mastectomy removes most of the nerves in your breast skin. You will notice a loss of sensation in this area. The feel or softness of the breasts will depend on the type of reconstruction performed. Implant-based reconstructions tend to produce firmer, less mobile breasts whereas using your own tissue results in more natural feeling breasts. Radiation therapy also influences both the sensation and softness of a reconstructed breast.
8. What postoperative care will I receive after my breast reconstruction?
Your plastic surgeon will follow you closely in the short term and continue to follow you at regular intervals for the long-term. Depending on the type of reconstruction, you will likely have bandages that will remain in place until your first follow-up visit. You may have intravenous pain medication if you stay in the hospital.
Depending on the type of procedure and your support at home, it may be arranged for a home care nurse to come to your home at regular intervals to help with both drain care and bandages.
You will also be prescribed oral pain medications and antibiotics for your recovery at home. You may have drains that can be removed at home by a home care nurse or during one of your follow-up visits.
9. What are my options to balance my reconstructed breast with the opposite side?
In the case of a unilateral (one-sided) mastectomy and reconstruction, you will have the choice to have additional surgery on the opposite side to better match the shape and/or size of your reconstructed breast if needed. Options usually include reducing or lifting the unaffected breast depending on what can be achieved with the initial reconstruction.
10. Are there any other additional surgeries I will need to consider?
Breast reconstruction is a process that is divided into stages. The first stage is the creation of a breast mound using either your own tissue or a tissue expander or implant. The second stage occurs at least three months later, and may involve finishing touches on the breast mound, exchanging the tissue expander for an implant, nipple/areolar reconstruction or balancing of the opposite breast if desired.
In the case of an implant reconstruction, the time between the first stage and the second stage may be longer to account for the time required to expand the breast skin. Nipple-areolar reconstruction can be done during the second stage or as a separate procedure at a later time. Generally, nipple-areolar reconstruction itself is a two-stage procedure with creation of the nipple in the first stage and tattooing of the areola (if desired) in the second stage.
In summary, most breast reconstructions will require two surgical procedures with up to two or three additional procedures until the final result is obtained.
11. Will I still need breast cancer screening after breast reconstruction?
Whether or not you have a reconstruction, a breast that has had a mastectomy does not require ongoing radiologic surveillance (MRI, mammogram or ultrasound). In the case of a unilateral (one-sided) mastectomy, the opposite breast would continue standard clinical and radiological breast cancer screening. Having breast reconstruction does not change these screening recommendations and does not interfere with the detection of recurrences. Questions about cancer follow-up, screening and monitoring for recurrence should be discussed with your breast cancer surgeon.
12. How do I decide what type of breast reconstruction is best suited for me?
This decision will be made in consultation with your plastic surgeon who will give you options based on whether one or both breasts are involved, the availability of your own tissue for reconstruction, previous or planned radiation therapy, overall health, and other personal factors.
In most cases, there will be an option best suited to you, which will be recommended by your plastic surgeon. The ultimate decision will be made between you and your plastic surgeon.