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The process of reconstructing a breast after a mastectomy — an operation to remove breast tissue, often in response to invasive breast cancer — is pretty complex. Experts and people who've undergone the process tell Bustle that it's also subject to a lot of myths and misconceptions. The key to understanding breast reconstruction after mastectomy, patients and doctors explain, is to know that it's not a one-size-fits-all operation.
"I usually explain the process of mastectomy by comparing the breast to an orange," Dr. Starr Mautner, a breast surgeon at the Miami Cancer Institute, tells Bustle. "The peel of the orange represents the skin and the actual flesh or fruit inside represents the breast tissue. For a mastectomy performed with an immediate breast reconstruction, the skin is preserved and the underlying tissue, or the fruit of the orange, is removed. In my practice, over 90% of patients who choose to have a mastectomy will also choose to have an immediate breast reconstruction."
For many people who've had a mastectomy, she tells Bustle, the idea of breast reconstruction is psychologically very important. A 2016 study found that immediate breast reconstruction can reduce psychological distress and increase positive body image in women who've undergone mastectomies. Breast reconstruction is becoming more popular; a study of breast cancer patients in the U.S. between 2005 and 2014 found that the number of people who chose breast reconstruction rose from 26.94% to 43.3%. Still, there's a lot about the process that continues to go unsaid. Patients and doctors tell Bustle what they wish people knew about reconstruction after mastectomy, and its results.
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There's More Than One Way To Reconstruct The Breast
Breast reconstruction after mastectomy doesn't fit one standard pattern. "The most common type of breast reconstruction is an implant-based reconstruction, where a temporary breast implant known as a tissue expander is filled partially with saline and placed temporarily under the chest muscle," Dr. Mautner tells Bustle. "This expander can then be expanded with more saline over the next several weeks to months and then exchanged for a permanent implant at a second surgery."
Another kind of breast reconstruction is known as flap surgery. "In the case of a 'flap', the reconstructive plastic surgeon will use tissue from the abdomen, buttocks, or thighs to reconstruct the breast," Dr. Mautner says. "This type of reconstruction can lead to a more 'natural result' as the tissue feels softer than an implant, but usually has a longer operative and recovery time. Patients who do not have enough fat or 'donor tissue' may not be a candidate for this type of reconstruction."
Some patients told Bustle that they hadn't been given the full range of options when they visited their doctors. "I think so many women get recommended to one doctor, that doctor tells you that you have this one option, and you think, 'I'll just have to take it,'" Erica, a breast reconstruction patient in her late 30s, tells Bustle. "But that's really not the case."
Allie Brudner, one of the founders of the nonprofit breast cancer support organization The Breasties, tells Bustle, "I did not know there were alternative options for reconstruction (direct to implant, flap surgeries, no reconstruction, nipple reconstruction, fat grafting). I didn't know that I could have some input on what my body would truly look like, or feel like."
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You Don't Necessarily Get Breast Reconstruction At The Same Time As A Mastectomy
Breast reconstruction is rarely a simple process and involves several steps. “I wish people understood that breast reconstruction after a mastectomy is a process and most often requires multiple surgeries, revisions and time," Joanna, 44, who had a mastectomy in 2017, tells Bustle. "Each person’s breast reconstruction journey is not the same." Since her initial surgery, tissue expanders and permanent implants two and a half years ago, she tells Bustle, she has had four further surgeries, including fat grafting, nipple reconstruction, and areola tattooing.
"While most patients who desire breast reconstruction undergo their reconstructive procedure immediately at the time of mastectomy, some patients opt for a delayed reconstruction and decide months to years later to pursue reconstruction," Dr. Mautner tells Bustle.
Reconstruction also needs to take into account other factors, like a person's ongoing cancer treatment.
"Since I had so many breast surgeries, ports, radiation, chemotherapy and so on, I was not an easy patient to operate on with any degree of success," Debbie, 49, tells Bustle. "I am very happy to say that I have had a great result that I am proud and grateful for every time I look in the mirror." (Debbie underwent a flap procedure at the Cancer Treatment Centers of America using fat from another part of her body.)
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It Doesn't Put You At Risk For Further Cancer
One common fear about reconstruction is that it might increase the risk of recurrence. But Dr. Mautner tells Bustle it doesn't have a basis in fact. "Many patients have the misconception that reconstruction puts them at a higher risk for cancer in the future," she says. "In most patients, immediate breast reconstruction is considered safe and does not put the patient at risk for breast cancer recurrence." While some people may experience recurrent breast cancer after reconstruction, studies indicate that this recurrence doesn't appear to be linked to implants.
However, Dr. Mautner tells Bustle, it's important that people considering breast reconstructive surgery have surgeons and carers who are qualified, to make sure the process is as well-done as possible and lowers risks for infection or surgical complications. "Patients should ensure that they are being seen by a board-certified plastic surgeon with experience in breast reconstruction after mastectomy," she says.
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"Perfect" Reconstruction Is Sometimes Not Possible
Breast cancers can vary widely, and the removal of tissue may mean that reconstructive efforts don't look as "realistic" as a pre-surgery breast.
"I just had my first revision surgery to improve some imperfections and tighten the pocket on my right side because the implant kept flipping over in my chest," Kate, in her early 30s, tells Bustle. "There is a large dip where I had lymph nodes removed near my left armpit that I hoped to fix, but my surgeon told me not to expect too much, saying, 'it’s hard to fix the absence of something'."
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Sensation In Reconstructed Breasts Can Differ
Sensation in reconstructed breasts depends on the particular procedure used, the mastectomy, and other factors, and patients tell Bustle it can take some time.
"I started getting sensation back in my flap reconstructed breasts after only five months," Erica tells Bustle. And research shows she's not alone.
A small 2019 study found that implant-based breast reconstruction tends to result in a loss of sensation in the breast tissue, while a 2017 study found that people who had flap reconstructions had a higher level of sensation in their reconstructed breasts compared to people with implants.
"In one 2018 study, only 2% of women gained full sensation in their breasts after a mastectomy," Dr. Anne Peled, a reconstructive plastic surgeon, wrote for Bustle in 2019. "While this fact is sometimes discussed during surgical consultation, many people are surprised to find out that they have lost sensation after surgery, and are then even more shocked to find out it’s often permanent."
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Not Everybody Is A Candidate For Breast Reconstruction
Breast reconstruction after mastectomy can be possible for those still undergoing treatment for cancer, experts tell Bustle. "Even in patients who require chemotherapy and/or radiation therapy after their mastectomy, immediate reconstruction is often an option as long as it does not delay their initiation of further treatment," Dr. Mautner tells Bustle. However, there are people who aren't good candidates for reconstruction.
"Certain patients with a rare type of aggressive breast cancer that can involve the skin, called inflammatory breast cancer, should not have an immediate breast reconstruction," Dr. Mautner says. "If a patient is not in good overall health and has significant co-morbidities, such as uncontrolled diabetes, they are also not good candidates for breast reconstruction as they are at high risk for complications, such as infections or wound healing issues."
Some people also choose not to have reconstructions even if they are good candidates for the surgery, because they feel empowered and comfortable without their breasts or don't believe the procedure is for them. The process of breast reconstruction is highly individual and everybody has a different approach.
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Patients May Not Be Happy With The Results Immediately
The process of breast reconstruction can be long, painful, and emotional, patients tell Bustle. "Breast reconstruction isn’t just one and done — there’s a lot of physical and emotional pain that comes with it," Kate tells Bustle. "I don’t regret my decision to move forward with a double mastectomy at all, but that doesn’t make the process any easier. My surgeon warned me that it was unlikely I’d be completely satisfied with the results after just the exchange surgery, and he was right."
A study published in JAMA Surgery in 2019 found that breast reconstruction patients often expect they'll feel comfortable with their new implants immediately following surgery, and the let-down can be considerable, even if the end product — after other surgeries and perhaps several years — might make them happier.
"I wish people understood that breast reconstruction after mastectomy is a process — it is as much mental as it is physical," Allie tells Bustle. "It was hard to navigate my new body. Physically, it took time and lots of physical therapy to feel comfortable and pain free. Emotionally, it takes time and work to not only love, but trust your new body."
Breast reconstruction surgery after mastectomy isn't a quick fix; it can be a complicated process with psychological implications. If you know somebody going through the process, experts and patients tell Bustle, it's a good idea to offer support while realizing that everybody's journey is individual.
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Expert:
Dr. Starr Mautner, breast surgeon at the Miami Cancer Institute
Studies referenced:
Bijkerk, E., van Kuijk, S., Beugels, J., Cornelissen, A., Heuts, E. M., van der Hulst, R., & Tuinder, S. (2019). Breast sensibility after mastectomy and implant-based breast reconstruction. Breast cancer research and treatment, 175(2), 369–378. doi:10.1007/s10549-019-05137-8
Brett, E. A., Aitzetmüller, M. M., Sauter, M. A., Huemer, G. M., Machens, H. G., & Duscher, D. (2018). Breast cancer recurrence after reconstruction: know thine enemy. Oncotarget, 9(45), 27895–27906. doi:10.18632/oncotarget.25602
Heine N, Koch C, Brebant V, Kehrer A, Anker A, Prantl L. (2018) Breast sensitivity after mastectomy and autologous reconstruction. Clin Hemorheol Microcirc. 67(3-4):459-465. doi: 10.3233/CH-179227. PubMed PMID: 28885214.
Ilonzo N, Tsang A, Tsantes S, Estabrook A, Thu Ma AM. (2017) Breast reconstruction after mastectomy: A ten-year analysis of trends and immediate postoperative outcomes. Breast. 32:7-12. doi: 10.1016/j.breast.2016.11.023. Epub 2016 Dec 16. PubMed PMID: 27988412.
Lee CN, Pignone MP, Deal AM, et al. (2018) Accuracy of Predictions of Patients With Breast Cancer of Future Well-being After Immediate Breast Reconstruction. JAMA Surg. 153(4):e176112. doi:10.1001/jamasurg.2017.6112
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