Is it possible to have a mastectomy and a breast reconstruction at the same time?
Overview
If your doctor has advised you to have a mastectomy, you may be wondering about breast reconstruction. Reconstructive surgery can be performed concurrently with mastectomy surgery. This is known as immediate reconstruction.
Immediate reconstruction has the advantage of avoiding at least one surgery. It may allow you to resume your normal life more quickly. There's also the psychological advantage of waking up from your mastectomy with your new breast or breasts more intact than if you didn't have reconstruction.
Furthermore, studies show that the cosmetic outcome of immediate reconstruction is often superior to that of later breast reconstruction.
Many factors influence the decision to perform both surgeries at the same time. To determine whether this is an appropriate option for you, consult with your breast cancer surgeon, oncology treatment team, and plastic surgeon.
What happens during immediate reconstruction?
During your mastectomy and immediate reconstruction, you will be sedated.
Typically, your breast surgeon will make an oval-shaped incision over the nipple area. The nipple can be preserved on the breast in some people with certain early breast cancers. This is accomplished by making incisions near the nipple or at the bottom of the breast.
Your surgeon will remove all of the breast tissue from the incision. Depending on the stage of your cancer and the surgical plan, they may also remove some or all of the lymph nodes under your arm.
The breast or breasts will then be rebuilt by the plastic surgeon. In general, a breast can be reconstructed using either an implant or your own tissue from another part of your body.
Prosthetic reconstruction (breast reconstruction with implants)
Following a mastectomy, implants are frequently used in reconstructive surgery. There are several types to choose from, each filled with either saline or silicone.
Immediate reconstruction with implants can be accomplished in a variety of ways. The technique may be determined by:
the plastic surgeon’s preference and experience
the condition of your tissue
the kind of breast cancer you may have
Some plastic surgeons will lift up the pectoralis muscle, which is located directly behind the breast, and place the implant behind the extra layer of tissue during a mastectomy.
Others will place the implant directly beneath the skin. To provide additional protection and support, some surgeons will place an artificial skin layer within the empty breast pocket.
Some things to consider when it comes to implants are:
Pros of implants
Cons of implants
Tissue flap reconstruction (breast reconstruction with your own tissue)
Implants are easier to insert and take less time, but some women prefer the more natural feeling of their own tissue in their reconstructed breast.
Furthermore, implants are more likely to cause complications if you have had or will likely have radiation therapy. Your surgeon will most likely then advise you on tissue flap reconstruction.
This type of reconstruction reconstructs your breast shape by using tissue from other parts of your body, such as your abdomen, back, thighs, or buttocks. The following are examples of flap procedures:
Flap procedure Uses tissue from
transverse rectus abdominis muscle (TRAM) flap abdomen
deep inferior epigastric perforator (DIEP) flap abdomen
latissimus dorsi flap upper back
gluteal artery perforator (GAP) flaps buttocks
transverse upper gracilis (TUG) flaps inner thigh
When considering this type of reconstruction, keep the following in mind:
Pros
Cons
Immediately after surgery
The time required for these procedures (per breast) can range from 2 to 3 hours for a mastectomy with immediate implant reconstruction to 6 to 12 hours for a mastectomy and reconstruction with your own tissue.
Following the completion of the reconstruction, your breast surgeon will attach temporary drainage tubes to your breast. This is done to ensure that any excess fluid has a place to go during the healing process. A bandage will be wrapped around your chest.
Side effects
The risks of immediate reconstruction are the same as those of any mastectomy procedure. They may include the following:
Because nerves are cut during the procedure, you may experience numbness along the incision site. Scar tissue may form around your incision site. It can result in pressure or pain.
Infection and delayed wound healing are common complications following a mastectomy. Both you and your doctor should be on the lookout for these symptoms.
Your nipple may not be preserved during a mastectomy. You will know whether your surgeon expects you to keep the nipple after the procedure before the procedure.
If your nipple is removed during your mastectomy, nipple reconstruction is usually done as a minor procedure several months after your breast reconstruction is finished.
What can you expect during recovery?
Depending on the type of reconstruction, expect to be in the hospital for several days. You may be hospitalised overnight for an implant reconstruction or for up to a week or longer for a reconstruction using your own tissue. During the healing process, your doctor will prescribe pain medication.
You may be told not to sleep on your side or stomach for a while. Scarring on your breasts is normal, even after reconstruction. The scars will fade in visibility over time. Scar removal creams and massage techniques can also help to reduce their visibility.
When you are discharged from the hospital, you will not be required to be on bedrest. The sooner you can stand up and move around, the better. However, you will be unable to drive or perform other upper-body tasks until the drains in your breast tissue are removed.
Driving while under the influence of certain pain relievers, such as Vicodin, is also prohibited.
There are no special dietary concerns, but you should focus on eating protein-rich foods. Cell growth and healing will be aided by these. Your doctor will prescribe safe exercises to assist you in regaining sensation and strength in your chest and upper body.
Other options for reconstruction
Other than immediate reconstruction and tissue flap reconstruction, there are other options for restoring your breasts to their pre-mastectomy appearance. These include having reconstructive surgery as a stand-alone procedure and not having any reconstructive surgery at all.
Delayed reconstruction
Delay reconstruction, like immediate reconstruction, entails either flap surgery or breast implants. Delayed reconstruction is more commonly chosen by women who require radiation treatments for their cancer after their mastectomy.
After your mastectomy, you will begin delayed reconstruction 6 to 9 months later. The timing will be determined by your progress through the cancer treatment and healing process.
The American Psychological Association studied the effects of delayed reconstruction in mastectomied women and concluded that immediate reconstruction was better for long-term mental health.
Alternatives to breast reconstruction
Mastectomy will be performed without reconstruction for women who are not good candidates due to health reasons or who simply do not want to have the additional surgery. The surgery flattens the chest on that side.
Women in these situations can request an external breast prosthesis after their incisions have healed. It can fill the affected side's brassiere and give the appearance of a breast under clothing.
Deciding which approach is right for you
Before making any decisions, ask your surgeon for a professional recommendation as you weigh your options. Every individual and clinical situation is distinct.
Having these two surgeries as part of one procedure may not be recommended depending on health factors such as obesity, smoking, diabetes, and cardiovascular conditions.
Women with inflammatory breast cancer, for example, must usually wait until they have completed additional treatment, such as radiation, before reconstruction can be performed.
Furthermore, smoking is a well-known risk factor for poor healing following reconstructive surgery. If you smoke, your plastic surgeon will almost certainly ask you to stop before considering reconstructive surgery.
Any type of reconstruction can increase the risk of side effects from a mastectomy, regardless of whether the reconstruction occurs immediately or later.
Discuss with your doctor
Many women are unaware of their options or that health insurance companies will cover reconstructive surgeries following a mastectomy.
Women with breast cancer are not always given the option of meeting with a plastic surgeon to discuss breast reconstruction after mastectomy, depending on their location and resources.
Speak up if you are not given this option. Request a consultation with your breast surgeon to determine whether breast reconstruction is right for you.
Before undergoing breast reconstruction after a mastectomy, there are numerous factors to consider. Before deciding on the best type of surgery for you, ask your surgeon the following questions:
Takeaway
A mastectomy can be a difficult procedure, and the prospect of additional surgery for reconstruction can be even more daunting.
In the short term, recovering from a mastectomy and reconstructive surgery at the same time may be more difficult. However, it may be less stressful and painful in the long run than multiple surgeries.