Moving on after breast cancer surgery means making one last decision about your breasts.
by The Iowa Clinic on Tuesday, March 5, 2019
Breast cancer puts women on a difficult journey. One that often leads to surgery. But the journey doesn’t end there. After a lumpectomy or mastectomy, women face another tough question:
How do I feel like myself again after breast cancer?
Once tissue is removed, the breasts never look or feel exactly the same again. The cancer is gone and you’re on the road to recovery, but the damage to your confidence and self-image can remain. If you don’t feel like yourself after breast cancer surgery, you have options:
- Get reconstructive surgery. Breast reconstruction allows you to permanently regain your breast shape or balance things out if you only had surgery on one breast.
- Wear a prosthesis. A breast form gives you the look of breasts under your clothes. It’s worn inside the bra or attached to the body to mimic the look, movement, feel and weight of natural breast tissue.
- Go flat. Many women who have mastectomies decide against prostheses or reconstructive surgery and choose to adjust to life without breasts.
Your choice is a personal one. And you don’t have to make it right away. You can decide to go flat in the time after your surgery and opt for a prosthesis or reconstruction down the road. But it’s best to speak with a plastic surgeon about reconstruction before you have breast cancer surgery so you can explore all your options.
What breast reconstruction options do I have?
The first thing that comes to mind is probably a breast implant. Breast implants are used in reconstructive surgeries just as they are in augmentation. You can select the size, shape and type — silicone or saline — of your implants.
Implants aren’t your only option. You can get reconstructive surgery using your own body tissue. Flap breast reconstruction — where tissue is transferred to the chest with its own blood supply — uses tissue from your tummy, back, thighs or behind to rebuild your breast shape. Since it uses actual body tissue, it looks, feels and behaves more like natural breast tissue than an implant — even getting bigger or smaller as you gain or lose weight.
Like with breast implants, you have options with this reconstruction procedure as well:
- TRAM flap breast reconstruction – Short for transverse rectus abdominus musculocutaneous, the TRAM flap procedure takes muscle, fat, skin and blood vessels from your abdomen to reconstruct the breast. It can tighten your belly, much like with a tummy tuck.
- DIEP flap breast reconstruction – Similar to a TRAM flap, the deep inferior epigastric perforator (DIEP) flap uses tissue from the abs. But it doesn’t take the muscle, which is better for your abdomen and less painful for you.
- Free flap breast reconstruction – Another procedure that pulls tissue from your tummy, free flap actually cuts tissue free from your abdomen and moves it to your chest.
Do I have to make a decision before breast cancer surgery?
No, there isn’t a deadline for a decision as big as this. You can get breast reconstruction done years after a mastectomy or lumpectomy. But it helps to talk to a plastic surgeon about your options beforehand because you may want to have reconstructive surgery at the same time as your breast cancer surgery.
If you prefer reconstruction but are nervous about another surgery, immediate reconstruction may be your choice. After the surgical oncologist removes your breast, a plastic surgeon reconstructs it with an implant or tissue. You get out of breast cancer surgery without cancerous tissue and with a rebuilt breast. Prophylactic mastectomy patients — those getting breast tissue removed to reduce a high risk of cancer – always get immediate reconstruction.
Not everyone has that option, however. You may need additional treatment like chemotherapy or radiation therapy. These treatments can cause your breasts to lose volume or change in appearance. Diabetes, circulatory problems and other health conditions are also cause for delayed surgery. So you may have to wait months for breast reconstruction.
You can also opt for reconstructive surgery any time after that. It might even be covered by insurance. Medicare covers breast reconstruction, and the Women’s Health and Cancer Rights Act of 1998 requires group health plans covering mastectomy to also pay for reconstructive procedures.
You’re not alone on your breast cancer journey. There’s a team of surgeons and specialists dedicated to your breast health who can help you weigh the types and the timing of breast reconstruction surgery.