A mastectomy is performed to prevent cancerous cells from spreading or to treat existent breast cancer and the entire breast is typically removed. When undergoing this procedure, many women choose the option of having a mastectomy with breast reconstruction, where the surgeon begins to rebuild the form of the removed breast immediately after the mastectomy.
Below we’ve outlined what a mastectomy with breast reconstruction entails, what options are available for women who choose breast reconstruction, and what to expect during recovery.
Breast Reconstruction Explained
When a mastectomy is recommended, women are generally presented with two options for breast reconstruction - immediate reconstruction and delayed reconstruction.
An immediate reconstruction involves starting the process of rebuilding the breast at the same time that the mastectomy is performed. A delayed reconstruction means the breast reconstruction begins months or sometimes a few years after the mastectomy, usually once breast cancer treatment has ended.
Unless impossible, most modern-day mastectomies are performed with skin-sparing in mind (also known as skin-sparing mastectomy), where surgeons save as much of the breast skin as possible to use for rebuilding the breast.
Breast reconstruction can be performed using implants (containing silicone or saline) or autologous tissue (tissue from somewhere else on the body). In some cases, surgeons will use both an implant and autologous tissue if there is not enough skin or chest muscle remaining after the mastectomy.
Once the implant or tissue has settled, the final part of breast reconstruction is to rebuild the nipple and areola in the case that they could not be saved during the mastectomy.
How Implants Are Used for Breast Reconstruction
Using implants for breast reconstruction involves two steps. During the first step, the surgeon will insert a tissue expander under the chest muscle or the breast skin. This tissue expander is then gradually filled with saline during intermittent visits to the surgeon.
Once the chest tissue has expanded and healed sufficiently, usually within 2-6 months, the expander is removed and an implant is inserted in its place.
Although most implants are inserted using this two-step procedure, implants can also be positioned within the breast at the same time that the mastectomy is performed i.e. the surgeon does not use an expander before the implant.
When Tissue from Another Part of the Body is Used for Breast Reconstruction
During autologous tissue reconstruction, when body tissue is used to rebuild the breast, the surgeon will take what is known as a flap, or portion of tissue that includes skin, blood vessels, fat, and muscle from another part of the body. The abdomen and back are the most common sites from which flaps are taken for breast reconstruction, however, the buttocks and thighs are sometimes used too.
Flaps are usually taken from the buttocks or thighs if a patient does not have sufficient abdominal tissue or has had previous abdominal surgery. In these cases, the surgeon might use an implant as well as a flap to ensure adequate volume is achieved for the reconstructed breast.
How are the Nipple and Areola Reconstructed after a Mastectomy?
Depending on the location of cancerous cells, as well as the shape and size of the woman’s breast, it is sometimes possible to preserve the nipple and areola during a mastectomy. This type of mastectomy is called nipple-sparing mastectomy.
If it is not possible to save the nipple and areola, the surgeon will wait until the breast has healed from the reconstruction. Once satisfied that the breast mound has sufficiently settled, the surgeon will begin the process of reconstructing the nipple and areola.
Reconstructing the nipple usually involves dissecting and relocating tiny pieces of skin from the rebuilt breast and slowly re-shaping the skin into a new nipple. The areola is sometimes constructed at the same time as the nipple by taking a skin graft from the abdomen or the groin.
In other cases, surgeons will wait several months until the nipple reconstruction has healed and then the areola is inked onto the skin like a tattoo. At this stage, some women prefer to have the tattoo done by a professional tattoo artist who specializes in 3-D tattoos that can make the areola appear more authentic.
How to Know Which Type of Breast Reconstruction is Best for You?
When choosing which type of breast reconstruction is best after a mastectomy, the surgeon will outline the most important factors to be considered for each patient.
For example, before surgery, a woman’s age and health will be reviewed, as well as whether the patient is a smoker, which can affect tissue repair. If implants are being considered, the shape and size of the breast will be discussed and a surgeon will need to confirm that enough skin and chest muscle will remain after the mastectomy.
Past surgeries, the location of cancerous cells in the breast, and whether reconstruction using autologous tissue is a possibility, are among other factors that the surgeon will examine.
The patients themselves might have additional aspects to contemplate before making a decision, like the follow-up visits required for implant expanders or the differences in recovery time for a procedure involving implants or autologous tissue. In short, each mastectomy and breast reconstruction is different, and choosing which type of reconstruction method is best for you will depend on the consultation with your surgeon.
Recovery Time After a Mastectomy and Breast Reconstruction
Dependent upon the type of breast reconstruction, patients are usually discharged from the hospital within 2-3 days. Typically, each surgical site will have a small tube in place to allow any excess fluid to gradually drain from each wound as it heals.
A medical professional will show patients how to care for these drains at home before they leave the hospital, and explain that they will stay in place until the surgeon is happy that the surgical sites have healed sufficiently.
After a mastectomy and breast reconstruction, patients can expect to feel sore and tired for about two weeks after the surgery, perhaps a little longer if a flap of autologous tissue was used as this will leave two surgical wounds as opposed to one. Doctors will prescribe medication to manage the pain and discomfort during this time.
According to previous breast reconstruction patients, recuperation can be made easier by having a recovery plan in place before the surgery. This might include pre-arranging someone to care for them post-surgery, a reclining chair to relax in during the day, a mastectomy pillow for comfort, a wedge pillow for elevated back sleeping, a belt to hold surgical drains, easy front-button clothing, and comfortable post-mastectomy bras.
Following the surgeon’s advice about sleeping positions and what bras to wear will provide added comfort while healing, as will the surgeon’s instructions on when to start mild stretching and physiotherapy, if required. As a general rule, overhead lifting, strenuous exercise, and sexual intercourse should be avoided for at least six weeks after breast reconstruction, and the surgeon’s approval must be obtained before any strenuous activities are resumed.
Expect recovery at home to take anywhere from 6-8 weeks before the body feels like it's getting back to normal. Some women may notice the feeling coming back to their breasts over time, while others may not. Swelling and bruising can take up to 8 weeks to subside and although the scars will never disappear completely, breast tissue will gradually heal over the following 1 to 2 years.
Any changes to skin color, swelling, lumps in the breast, or leakage from surgical sites after the drains have been removed should be immediately reported to a healthcare practitioner.
Lastly, it is highly recommended that women undergoing a mastectomy and breast reconstruction speak with a therapist or a breast cancer support group to come to terms with the physical changes to their body. A Mastectomy and breast reconstruction is not an easy time to go through, and self-care is paramount for recuperation and quality of life in the aftermath.
Mammograms After a Mastectomy & Breast Reconstruction
As a general rule, women who have undergone a mastectomy and breast reconstruction will not have regular mammograms on the side where the breast was removed. Although cancer could return in the chest wall of that breast, there would not be enough tissue to perform a mammogram, so doctors carry out regular physical exams instead. If the other breast was not affected, however, regular mammograms should still be scheduled on that side.
If you are not sure whether you need to schedule regular mammograms after your mastectomy, consult with your doctor to make sure.
When a mastectomy is carried out to remove breast cancer or prevent cancerous cells from spreading, many women are given the option of breast reconstruction at the same time. To understand the options, and the differences between procedures involving implants and flap reconstructions, consult with your surgeon.
Additionally, it is recommended that women undergoing a mastectomy and breast reconstruction, make a recovery plan and get organized with everything they’ll need to recuperate before the surgery takes place.
Mastectomy: What to Expect - https://www.breastcancer.org/treatment/surgery/mastectomy/expectations
American Society of Plastic Surgeons - Breast Reconstruction - https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction
What Happens After Breast Surgery - https://www.cancerresearchuk.org/about-cancer/breast-cancer/treatment/surgery/after-surgery/what-happens-after-surgery
National Cancer Institute – Breast Reconstruction after Mastectomy - https://www.cancer.gov/types/breast/reconstruction-fact-sheet
National Library of Medicine - Nipple Sparing Mastectomy – Is it Worth the Risk - https://pubmed.ncbi.nlm.nih.gov/22024947/
Checklist For Recovery After Mastectomy - https://www.nationalbreastcancer.org/blog/checklist-for-recovery-after-mastectomy/