5 things you need to know about breast reconstruction

1. Not to be confused with a “boob job”

PLEASE READ CAREFULLY: There is a MASSIVE difference between someone who chooses to have plastic surgery to enhance the size of their breasts or change the shape of them vs. someone who undergoes a mastectomy or prophylactic surgery. One is elective and the other is life-saving. The distinction is important because those that did not choose to have surgery don’t feel like they are getting a great pair of breasts out of the deal. Often losing your breasts comes with losing your sense of femininity and it is deeply tied to body image and self-esteem. For women that have gone through breast cancer, it can also be a sober reminder of that experience.

Breast reconstruction is a surgery or surgeries to restore the breast shape that was partially or completely removed. Breast reconstruction can be performed with implants or with the body’s own tissue. When the breast tissue has been removed by mastectomy, only a thin layer of skin remains so usually the implants will go in front of the chest wall but behind the chest muscles.  The absence of breast tissue after mastectomy can make it more difficult to achieve a natural look and feel and at times you can see the muscles flex in front of the breasts.  For women who have one natural breast and one reconstructed breast, it is difficult to match an implant to the shape of the other breast’s natural shape and achieve symmetry.

Some or all of the breast tissue and nerves are removed, women will have loss of sensation and possibly not have any feeling in their reconstructed breast or breasts at all.

2. One size doesn’t fit all

At Rethink we often repeat this slogan when it comes to cancer treatment. Like precision medicine, reconstruction should be tailored to the individual. There are many factors to consider when it comes to choosing which method is best for you. A good plastic surgeon should help guide you through the process of determining what is best, keeping in mind size, shape and the ability to match an existing breast in the case of a unilateral mastectomy. In general, reconstruction either uses existing tissue from the body or a synthetic implant. For more information on various procedures and methods click here.

3. Not everyone chooses reconstruction

Breast reconstruction is not a mandatory part of cancer treatment. For many women who have had breast cancer, having their breasts reconstructed can be an agonizing decision to undergo more surgery after going through the mental and physical exhaustion of breast cancer treatment.

They must take into account the various surgical options while weighing what they perceive may be the physical and emotional benefits and the impact on their sense of desirability; versus the potential problems and disappointments. Many women have difficulty accessing information and resources to help them understand their choices and their potential impacts, making a challenging decision even more difficult: to reconstruct or opt out of reconstruction altogether.

Here is a great panel discussion on the topic which took place during Breast Fest at the Scar Project a few years ago:

4. Nipples are a whole other thing

Often in the case of breast cancer, the nipple is not spared because it is still attached to breast tissue which could be come cancerous. This what a woman’s breast often looks like post reconstruction.

Women are told to let their new breasts settle for at least 3 months so that the nipple and areola can be placed in the proper position. This means that the nipple is literally the cherry on top. It needs its own method of reconstruction and there are different methods for that too including:

• using tissue and fat of the reconstructed breast
• using tissue from the opposite nipple if it is large or very pointy (if you have had a unilateral mastectomy
• using tissue from another part of the body (labia is the most common)
• tattoo alone

Options for reconstruction of the areola include:

• tattoo alone
• skin graft from abdominal scar or groin crease
• using tissue from your other areola (if you have a large opposite areola and have had a unilateral mastectomy)

In the case of tattooing it is important to find someone who is experienced in 3D nipple tattoos, like Vinnie Myers.

5. Reconstruction can be a waiting game

Last year in Canada, Rethink brought the issue of lengthy wait times to the Ontario Minister of Health who then appointed Cancer Care Ontario’s Breast Reconstruction Working Group & Expert Panel. We struck an expert committee of our own and conducted a literature review and in-depth survey of patients and surgeons in Ontario to understand the scope of the wait time issues of prophylactic mastectomy and breast reconstruction surgery.

Based on our research it was clear that there were some issues around wait times for those needing reconstruction.

Our report Deconstructing Breast Reconstruction makes the following recommendations to the Ontario government:

1. Add prophylactic mastectomy with immediate reconstruction to the list of cancer surgeries funded by Cancer Care Ontario (CCO.)
2. Ensure that data on these surgeries be collected and measured so CCO can better understand the demand for this surgery and assign resources accordingly.
3. Increase surgical resources in the province (like Operating Room time) to benefit all patients looking to access breast reconstruction.

So far numbers 1 and 2 have been implemented, and we are hopeful that increasing surgical resources in the province will follow!

For more information on reconstruction click here.