There are different options and routes to take during the breast cancer journey, depending on your diagnosis, as each situation is unique. Among the different possible treatment plans, a mastectomy may be suggested, which means that a decision about reconstruction will have to be made. This choice is very personal, and either option is valid. The decision may be obvious for some people; more difficult for others.  

In order to possibly help and support you in your choice, the Foundation has put together some information and resources:

What are your options?  

First of all, it is important to know that breast reconstruction after surgery is covered by the Régie de l’assurance maladie du Québec (RAMQ).

The choice of the type of reconstruction also depends on various factors, such as the treatment plan, the availability and health of replacement tissue, certain physical characteristics, and the general state of health, since reconstruction–or certain reconstruction techniques–are not always possible. Therefore, it is important to ask your plastic surgeon to explain the different techniques, and to tell you which are suitable for you. The timing of the procedure may also vary from person to person: you may have immediate reconstruction, at the same time as your breast surgery, or you may have it at a later date, which is called delayed reconstruction.

Each of these options has advantages and disadvantages. If you have to choose, you may want to ask your healthcare team if the options you will be offered later will be the same, and if you will have the same results. You may also want to discuss the cosmetic outcome, and the different possibilities available to you while you await reconstruction.

Although delayed reconstruction can be offered within a variable time frame after treatments have stopped, be aware that if you are not ready at that time, it will always be possible to postpone reconstruction until later, or not to have it at all.

The main reconstruction techniques are:

• Implant reconstruction: This method involves inserting a breast implant filled with sterile saline or silicone gel behind the pectoralis (major chest muscle). When the amount of remaining skin is insufficient or reconstruction is delayed, it is possible to insert an expander to gradually stretch the skin and prepare it to receive the final implant in a second phase;

• Autologous reconstruction: Autologous (flap) reconstruction: this method involves using your own tissue, which may come from different parts of your body, such as the lumbar region or the abdomen, to reconstruct the missing breast;

• Flat closure reconstruction: This technique consists of not reconstructing the surgically removed breast, but ensuring that the chest is as flat as possible.

Assessing the different options  

If you are unsure of which reconstruction option to choose, there are many factors to consider in your decision. Understanding what to expect can help you decide what is best for you!

Remember, however, that your healthcare team is your best resource to guide you. Do not hesitate to ask your plastic surgeon questions before the mastectomy, or to express your expectations regarding breast reconstruction.

Depending on the options you are considering, here are 10 things you might want to know that could affect your choice:

• The sequence and different stages of  the procedure;  

• The possible side effects; 
• The impact on the body’s sensations, especially the nipple; 
• The duration of the convalescence and the time needed to resume normal activities; 
• The expected cosmetic result; 
• In the case of autologous reconstruction, the impact depends on the place of tissue harvesting; 

• In case of implant reconstruction, the lifespan, and safety of the prosthesis and your comfort with having it in your body; 
• The long term: the impact of aging on the reconstructed breast; the need for further surgery in the future; 
• The possibility of changing your mind or having another procedure later;  
• The logistical and financial implications.  

What then?   

Sometimes reconstruction of the affected breast results in an unevenness of shape, volume, or height in relation to the natural breast. Ask your healthcare team about the possibilities of achieving symmetry with the other breast. There are options to make your breasts look better after the operation: an augmentation or reduction of the other breast, or a “breast lift.” You can also use other methods such as:

• External breast prosthesis (also known as breast form): complete or partial, in foam or silicone, it can be used to compensate for asymmetry. If you wish to wear an external breast prosthesis, the RAMQ External Breastforms Program reimburses such a prosthesis every two years; 
• The adapted bra: a bra with pockets for an external breast prosthesis or adapted for flat reconstruction.

Breast cancer surgery sometimes results in the removal of the nipple and areola. There are several possible reconstruction methods: 

• Flap: your own tissue (skin and fat) is used to reconstruct your nipple;

• Graft: part of the nipple of the unaffected breast is used to form the nipple of the reconstructed breast;
• Tattoo: a tattooed design can give the illusion of a three-dimensional areola and nipple.
• Artistic tattoo (permanent or temporary): this might also be considered. You can consult this map of post-mastectomy tattoo artists to discover some in Quebec.  
• Artificial nipple (sticker).

So there are many options available to you after your breast cancer surgery, depending on your situation.

Moving toward a new self-image 

We understand that the post-breast-cancer reconstruction process is as much physical as psychological. It is therefore quite normal to feel different emotions, doubts, or questions related to this ordeal. It is important to always listen to your feelings and emotions.