What will happen to my breasts?
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That is one of many questions women face when they are diagnosed with breast cancer. Fortunately, women have better breast reconstruction options than ever before. In most cases, reconstruction can even begin at the same time as a mastectomy.
“Often, just knowing that there are options helps women plan and get through a difficult time,” says plastic surgeon Graham Schwarz, MD. “We can help them feel whole again.”
There are two main categories of reconstruction: implant-based and own-tissue-based. What you choose will depend on your personal goals, medical history, body type, treatment plan and many other factors.
Implant-based reconstruction offers good aesthetic results for many women, Dr. Schwarz says. Results are often best in women with small- to medium-sized frames.
Surgeons most commonly place a tissue expander — think of it as a placeholder — during the initial surgery, then place permanent implants later. This type of reconstruction does not add substantial time to the mastectomy and does not prolong the hospital stay. Recovery time is typically about two to three weeks.
“I always advise patients that reconstruction is a process. But if you weigh the pros and cons and make the right decision for yourself, you can get very good results.”
“For women interested in a shorter recovery,” Dr. Schwarz says, “this is often a good approach.”
Like any procedure, breast reconstruction with implants comes with drawbacks. For one thing, it happens in stages and may require multiple minor in-office procedures after the initial surgery. Some women may develop excessive scar tissue, implant leakage or implant rupture over time, so you may need additional procedures in the future.
This type of reconstruction has one distinct advantage: It uses your tissue, taken from the lower abdomen in the case of the “DIEP flap” reconstruction.
“This tissue gains and loses weight with you and changes as your body changes,” Dr. Schwarz says. “The consistency is like your own breast tissue, and it’s arguably a more natural appearance.” And because you’re not placing foreign objects — implants — in your body, there’s less risk of infection and scarring issues and no risk of rupture.
However, own-tissue reconstruction requires about four to five days in the hospital for monitoring, and recovery time is about four to six weeks. In addition, very thin women who do not have a lot of extra tissue may not be candidates.
Timing is everything
Many women don’t realize they have options related to the timing of reconstruction, Dr. Schwarz says. In the past, the delayed approach was the norm. Reconstruction took place after treatment and surgeries such as mastectomy were complete.
Now most women can have immediate reconstruction — meaning the first stage of surgery is done at the same time as a mastectomy. For women with just the right body type and treatment plan, there are even single-stage reconstructions, when the implants or tissue can be placed right then and there, without additional reconstructive surgeries.
However, a mixed approach may be better for women who need radiation treatment after surgery and prefer their own tissue. Your surgeon may want to place a tissue expander during the mastectomy to preserve the breast skin, then wait to complete the final reconstruction. “Radiation and chemotherapy are important, but can make tissue healing a challenge,” Dr. Schwarz says. “That’s why we always work closely with other physicians on the multidisciplinary breast cancer team.”
Regardless of which option you choose, be patient.
“I always advise patients that reconstruction is a process,” Dr. Schwarz says. “It can take up to a year and a half. But if you weigh the pros and cons and make the right decision for yourself, you can get very good results.”