You and your doctors have decided that the right treatment for your breast cancer is a mastectomy. But then comes the $ 64,000 question: Do you want to rebuild? There is a lot to consider when making a decision.
Use these questions to better understand your options.
First decision: should you even do it?
Millions of women are choosing to rebuild, and the number is increasing. The Agency for Research and Quality in Health Care (AHRQ) reported in 2017 that breast reconstruction after mastectomy increased by 62% from 2009 to 2014, with 40% of women who had a mastectomy opting for reconstruction.
Much research has also been done over the years that women who undergo reconstruction simply feel better, with improved psychological, social, emotional, and functional improvements.
Second decision: immediate or delayed reconstruction?
The benefits of immediate reconstruction are obvious: you will wake up with a breast or breasts and (hopefully) not have to undergo additional surgery if you are undergoing or recovering from treatment. One patient said that the psychological benefits of looking exactly the same as in hospital immediately after surgery were enormous for her.
However, this method may not be suitable for everyone. It works best for women in good general health. It is also important that the reconstruction does not interfere with cancer treatments such as radiation. This is why it is so important to involve all of your doctors. Despite the risks, one study showed that even women who need radiation after mastectomy are increasingly choosing to have immediate reconstruction.
Third decision: flap (autologous) or implant (alloplastic)?
There are two types of reconstruction: flaps or implants. This decision needs to be made closely with your doctor as not everyone is an option for both methods. The valve-based, or autologous, approach is for the surgeon to use your own tissue to create a breast. One advantage of this approach is that nothing can later tear, which can be a risk with alloplastic implants.
One disadvantage is that the tissue used for this reconstruction method can come from your stomach, thighs, back, or buttocks. You will have pain in more than one area of your body after surgery. When the tissue is removed from the stomach, some women actually consider it a professional – it’s like getting a tummy tuck thrown in!
If implants are an option for you and you choose to go this route, reconstruction can be done in a step or two. Sometimes the implant can be used if you are going to have a mastectomy. Otherwise, the surgeon will use a tissue expander after the mastectomy. This is a silicone insert that is gradually filled with saline to stretch the skin. The implant is inserted a few months later.
You may want to take into account that implants are not a permanent solution and you may need additional surgery to remove or replace them later. However, even a flap reconstruction could require additional surgery over time.
Fourth decision: silicone or saline?
When you have decided on implants, you have to decide on one type. Both trays are made of medical grade silicone, but the saline implants are filled with sterile saline solution, while the silicone implants are shaped by a silicone gel insert. Like all of your options, each has its advantages and disadvantages.
For example, many women (and doctors) think silicone has a more natural appearance than saline, but saline implants are filled after insertion, often resulting in a smaller incision. Regardless of which type you choose, if the implant tears, the shell must be removed. With a saline implant, the saline solution is absorbed into your body. This is another decision that you should make with your doctor.
Fifth choice: one breast or two?
Even if you’ve just had a mastectomy on one breast, you may want to get an implant on the other breast so that they match in shape and size.
Remember, you don’t have to make all of these decisions right away. It is a good idea to focus on treatment first. But when the time is right, it’s important to speak to your doctors about all of the options so that they can find the one that works for you.
This resource was created with the assistance of Allergan.