Breast Reconstruction Options After A Mastectomy: Everything You Need To Know

Breast reconstruction is an essential part of the healing journey for many individuals who undergo a mastectomy. It offers the opportunity to restore the appearance of the breast and can play a significant role in emotional and physical recovery. If you or a loved one is considering reconstruction, understanding the available options can help you make an informed decision that aligns with your needs, lifestyle, and goals.

Breast reconstruction can help:

• Restore breast shape and symmetry.

• Boost self-confidence and body image.

• Provide a sense of closure after cancer treatment or preventative surgery.

It’s important to note that breast reconstruction is a highly personal choice. Some individuals may choose not to have reconstruction, and that decision is equally valid.

Types of Breast Reconstruction

There are two primary types of breast reconstruction: implant-based reconstruction and autologous (flap) reconstruction. Each approach has its benefits and considerations, and the choice often depends on factors like personal preference, overall health, and the type of mastectomy performed.

1. Implant-Based Reconstruction

This method involves the use of saline or silicone implants to recreate the breast shape. It is one of the most common reconstruction techniques.

Procedure:

• Tissue Expander: A temporary expander may be placed to stretch the chest skin and muscle gradually.

• Implant Placement: Once the tissue has been stretched sufficiently, the expander is replaced with a permanent implant.

Pros:

• Shorter surgery and recovery time compared to flap reconstruction.

• No additional surgical sites on the body.

Cons:

• Implants may require replacement over time.

• Risk of complications, such as implant rupture or capsular contracture.

2. Autologous (Flap) Reconstruction

This technique uses tissue from other parts of the body, such as the abdomen, back, or thighs, to rebuild the breast.

Common Flap Types:

• DIEP Flap: Uses skin and fat from the lower abdomen without affecting abdominal muscles.

• TRAM Flap: Includes abdominal muscles, skin, and fat.

• Latissimus Dorsi Flap: Tissue is taken from the upper back.

Pros:

• Provides a natural look and feel.

• No risk of implant-related complications.

Cons:

• Longer surgery and recovery time.

• Additional scars at the tissue donor site.

3. Combination Reconstruction

In some cases, surgeons may combine implants with flap reconstruction. This can be a good option for individuals with insufficient tissue for a full flap reconstruction.

Timing of Reconstruction

Breast reconstruction can be performed either immediately during the mastectomy surgery or delayed until after other treatments, such as chemotherapy or radiation.

• Immediate Reconstruction: May reduce the overall number of surgeries and provide psychological benefits.

• Delayed Reconstruction: Allows the body to heal fully and avoids potential interference with cancer treatments

Choosing the Right Option

Selecting the best reconstruction option involves collaboration with your healthcare team. Consider:

• Your medical history and cancer treatment plan.

• Your body type and available tissue.

• Desired aesthetic outcomes.

• Willingness to undergo multiple surgeries or extended recovery.

It can also be helpful to speak with others who have undergone reconstruction or seek support from a counselor or support group.

Breast reconstruction after a mastectomy is a deeply personal decision, and there is no one-size-fits-all approach. By understanding the various options and discussing them with a trusted, board-certified surgeon, you can make a choice that feels right for you.

Your journey is unique, and every step you take toward healing and recovery is a testament to your strength and resilience. If you’re considering breast reconstruction, take the time to explore your options, ask questions, and advocate for yourself. You deserve care that supports both your physical and emotional well-being.

Mastectomy Must Haves For Recovery

I’m often asked, “What do I need to have at home after my mastectomy?” Good question! The best way to have a smooth recovery is to have everything you need in advance. Below are my recommendations to have on hand at home and the “whys” behind them. 

• Post-mastectomy pillow

• Oversized, satin or silk comfy button-down shirts and PJs with inside pockets

• waist drain pouch or apron

• ice packs

• Mastectomy bras

• wedge pillow

• extra pillows

• big body wipes and dry shampoo

• large side table or dresser

• bed tray

• SPILL-PROOF CUP or water bottle with a bendy straw

• Tylenol, (acetaminophen)

• Ibuprofen (Motrin, Advil)

• Colace (docusate sodium)

A Post-mastectomy pillow. This is a pillow that you wear that protects your chest. It’s especially helpful when leaving the hospital. When in a car, this will keep the seat belt directly off your chest. Think of it as an “airbag” for your breasts. Many of my patients like to wear it at home as well. It’s an extra layer of protection between them, their kids, their dog, and those pesky walls that seem to jump out at you. They also have pockets for ice packs, cell phones, etc. 

Oversized, comfy button-down shirts and PJs with inside pockets to hold your drains. Why? You won’t be able to raise your arms after surgery so being able to slip in and out of a top easily is key. Also, choosing a satin or silk material is best as it helps you reposition yourself in bed easier and helps you to get in and out of bed more easily. The inside pockets for the drains keep them tucked away so they’re not dangling freely. Alternatively, a waist drain pouch or apron is also a good choice. You wear this on the outside of your clothes like a 1950s housewife. Think function not fashion. 

After a mastectomy, you’ll have bruising and swelling around your breast and under your arms. Many doctors recommend using ice packs for swelling. However, many advise against it particularly if you’ve had a tissue expander placed for a future breast implant. Do not use ice unless your surgeon advises you to do so. 

Mastectomy bras. They’re made of a stretch fabric with a front Velcro closure. They provide compression and help with healing. Most surgeons will give you one or two mastectomy bras to go home with after your surgery. If you need to buy more they will go over which ones are best for you. 

If you’re not going to be sleeping in an adjustable recliner, get a wedge pillow for your bed. As you will be sore, this is a game changer for positioning yourself and getting up from your bed easier. Also, have extra pillows on hand for making a “pillow Throne” and to support your arms. 

As your surgeon will not want you to get your incisions and drains wet, buy big body wipes and dry shampoo to keep yourself feeling fresh and clean. 

Having a large side table or dresser next to your bed is important as you’ll want to have the items you need and want close by. Think cell phone, medications, drinks, snacks, tissues, pen and paper, etc. Also, if you plan on eating in bed I recommend a bed tray table and a spill-proof cup or water bottle with a bendy straw. Bendy straws are the unsung HEROES of spill prevention when you’re lying down and don’t get enough credit. The last thing you need is to have to change all of your sheets in the middle of the night because of a spill. 

Also, have Tylenol (Acetaminophen), a pain reliever and fever reducer, and Ibuprofen (Motrin or Advil), a pain reliever and anti-inflammatory medication on hand for pain. However, do not take them without first checking with your doctor if they are right for you and your particular surgery. As you might be sent home with narcotics for pain, some may have a Tylenol or anti-inflammatory component built into them already. 

Speaking of narcotics, a common side effect of them is constipation. Often after not “going’ for a few days, it can become a big worry for patients. Make sure you have Colace (docusate Sodium) at home. It’s an over-the-counter stool softener. Again, do not take it without first checking with your doctor. Also, here’s a not-so-obvious tip - have at home any drinks or food that you know typically makes you “go”. For a lot of people, it’s coffee and fruit. And think about having good old-fashioned prunes on hand. It’s old school but it works.

Other good tips I tell my patients especially if they’re home alone after surgery is to place all the items that you’ll need at home at arm’s reach before you have your surgery - plates, cups, food, toiletries, clothes, etc., as you won’t be able to lift your arms to reach for these things. And speaking of alone, my best piece of advice is don’t be alone. Many patients underestimate how they’ll feel after a mastectomy - tired, groggy, uncomfortable, even depressed. Always plan to have someone with you.