Many women who have a mastectomy surgery to remove an entire breast to treat or prevent breast cancer have the option of having the shape of the removed breast rebuilt.

• Women who choose to have their breasts rebuilt have several options for how it can be done.
• Breasts can be rebuilt using implants (saline or silicone).
• They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body).
• Sometimes both implants and autologous tissue are used to rebuild the breast.
• Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction).
  • Delayed reconstruction can happen months or even years after the mastectomy. •
• In a final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.
• Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.

• One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy.
  • Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed.
  • However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy.
  • Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.
• Another factor is the type of breast cancer.
  • Women with inflammatory breast cancer usually require more extensive skin removal
  • This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.
• Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction.
  • For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment.
  • Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

Surgery and recovery

• Enough skin and muscle must remain after mastectomy to cover the implants
• Shorter surgical procedure than for reconstruction with autologous tissue; little blood loss
• Recovery period may be shorter than with autologous reconstruction
• Many follow-up visits may be needed to inflate the expander and insert the implant

Possible complications

• Infection
• Accumulation of clear fluid causing a mass or lump (seroma) within the reconstructed breast
• Pooling of blood (hematoma) within the reconstructed breast
• Blood clots
• Extrusion of the implant (the implant breaks through the skin)
• Implant rupture (the implant breaks open and saline or silicone leaks into the surrounding tissue)
• Formation of hard scar tissue around the implant (known as a contracture) diabetes, and smoking may increase the rate of complications
• Possible increased risk of developing a very rare form of immune system cancer called anaplastic large cell lymphoma

Other considerations

• May not be an option for patients who have previously undergone radiation therapy to the chest
• May not be adequate for women with very large breasts
• Will not last a lifetime; the longer a woman has implants, the more likely she is to have complications and to need to have her implants removed or replaced
• Silicone implants may feel more natural than saline implants to the touch
• The Food and Drug Administration (FDA) recommends that women with silicone implants undergo periodic MRI screenings to detect possible “silent” rupture of the implants.