More than half of breast cancer survivors make decisions about breast reconstruction that don't actually align with their priorities, research shows. Maybe your top priority is a fast recovery. Or, maybe your main goal is to end up with breasts that look and feel the most like natural breasts. These very different goals can lead to different choices for reconstruction after mastectomy.
But, when you are dealing with a breast cancer diagnosis, there's a lot to take in. You'll get a lot of information about your cancer treatment options. You'll have additional choices about reconstruction, too. In order to make sure that you go with the choice that best fits your goals and is best for your health, it's important to understand all your options and the risks and benefits of each.
Read MoreYou May Have Several Surgery Options
Plastic surgeons can reconstruct your breasts with implants or with your own tissue taken from some other place on your body, such as your back, your abdomen or your inner thigh.Dr. Andrea Pusic weighs the pros and cons of implants versus your own tissue.
Reconstruction that uses your own tissue is called a flap procedure. A flap can produce breasts that look and feel more natural than implants. Like natural breasts, they can also change as your body changes. For example, they can get bigger or smaller as your weight changes.
But, flaps require more surgery and longer recovery time than breast implant surgery. The procedure leaves more scars, too. You'll have a scar by the reconstructed breast and another at the "donor site," where the surgeon takes the tissue from. This procedure can also damage or weaken the muscle at the donor site. Some women might not be candidates for this type of surgery. For example, women who smoke, have poorly controlled diabetes, circulation problems or connective tissue disorders might not be able to get a flap procedure.
Related: Saline vs. Silicone Implants; Which Is Right for You?
Breast implant surgery typically requires fewer surgeries, fewer cuts, and leaves fewer scars. All of this means, you'll be back to your usual life sooner. But, implants won't look and feel like as much like natural breasts. As you age or gain or lose weight, the implants will stay the same, which could make them look less natural over time. Implants can sometimes leak or burst. In this case, you would have to have them replaced.
Every surgery has risks. Make sure you understand the risks of each of your options.
Dr. Sarah Cate explains how some women may keep their breast size and shape in cancer surgery.
To Reconstruct Now or Later
Depending on your cancer treatment plan and the type of reconstruction you will have, you might be able to begin breast reconstruction during the same surgery as your breast cancer surgery.
The Women's Health and Cancer Rights Act of 1998 requires that group health plans, health insurance companies and HMOs cover breast reconstruction at any time even years later after your mastectomy.
Immediate reconstruction can get better-looking results than delayed reconstruction, and it can mean fewer surgeries overall. But, it may mean a longer initial hospitalization and recovery time. This long surgery may also have a higher risk for complications, such as infections, than two separate surgeries.
"Delayed reconstruction," Myckatyn says, "according to most studies has fewer complications than immediate reconstruction."
If radiation is a part of your treatment plan after breast-cancer surgery, your doctors might recommend you delay breast reconstruction. Radiation can damage the reconstructed breast. But, that's not the only reason some women wait. Some women want to focus on their cancer treatment and think through their choices for reconstruction later. Some want to break up the surgeries and hospital time to help ease recovery. Others may have initially considered opting out of reconstruction and then change their mind later. The law protects your right to do so.
The Women's Health and Cancer Rights Act of 1998 requires that group health plans, health insurance companies and HMOs cover breast reconstruction at any time even years later after your mastectomy.
"I've done a breast reconstruction 42 years after breast cancer surgery," Myckatyn says.
If your employer is self-insured or if you have a church or government health plan, find out if they are required to cover reconstruction. Medicare and Medicaid cover it.
Related: 5 Well-Known Breast Cancer Survivors and What They’ve Learned
"But there are downsides to delayed reconstruction," Myckatyn says. "You can lose some of the options that were available to you if you delay because you don't have as much breast skin to work with. This can be because it contracts [with scarring], or it's been removed, or it's had radiation."
The Choice to Go Flat
Maybe as many as 44 percent of women choose to go flat. That is, after their mastectomy, they don't have any breast reconstruction at all. It's unclear exactly how many women choose this since some women in that count may go back for reconstruction later. For those who don't go back for reconstruction, people call this "going flat" or "living flat."
Some women may choose to wear prosthetics that form the shape of a breast always or on some occasions. Others may choose never to wear them.
Dr. Andrea Pucic answers the question: Are breast implants dangerous?
Women who live flat may do this for any number of reasons. Maybe their health isn't good enough to have the additional surgery that reconstruction requires. Or, perhaps the shortest recovery time is her top priority, so she can return to her regular activities. Some women say they find it very liberating.
A Very Personal Decision
Your options and your decision will depend on your health, your cancer treatment plan, and your personal priorities and goals.
No matter what you plan to do and when, don't wait to discuss your options with a plastic surgeon who does breast reconstruction. Start the conversation with the breast surgical oncologist who will perform the surgery to remove the cancer. Your reconstruction plans may impact how the surgeon does the mastectomy and the location and appearance of the scar.
Related: 'I'll Swim Topless': Comedian Tig Notaro On Owning Her New Body After Double Mastectomy
"The biggest factor in the outcome of breast reconstruction is how the mastectomy is done. Find a surgical oncologist who has a good reputation, whom you are comfortable with, and who refers you to a plastic surgeon right out of the gate," Myckatyn says.
As you work through your decision, first ask yourself what matters most to you. What's your answer to these questions:
- How important to me is a permanent breast shape?
- How quickly do I want to get back to my normal routine?
- How much risk am I willing to assume?
- How many procedures am I willing to undergo?
Ask a breast surgeon these questions:
- What are the advantages and disadvantages of each option available to me?
- How many procedures does each option require?
- What is the recovery time for each?
- What are the risks and the probability of each?
- What can I expect my breasts to look and feel like?
- Can I do reconstruction later?
- What are the advantages and disadvantages of doing it now?
- Will my reconstruction options change if I wait?
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