Breasts are an important body part for many women. Breast loss or deformity after breast surgery is often difficult to accept.
There are many options available to you to relearn to like how you look and feel better about yourself. External breast prostheses or breast reconstruction are possibilities, depending on your needs, desires and lifestyle.
But you can also opt out of breast reconstruction. Ultimately, you should be comfortable and at ease with your decision. All choices are available to you. Consider the options and choose what’s best for you!
The right to a flat or asymmetrical chest
Following a mastectomy, some women do not wish to have traditional breast reconstruction or wear an external breast prosthesis. Instead, they prefer to have a flat or asymmetrical chest. This is their way of redefining their bodies after breast cancer – a choice that is just as valid.
If you envision keeping your chest or breast flat post surgery, mention the decision to your surgeon, and ensure that this choice is indicated on your surgery request form. There are many equivalent terms that refer to the procedure of keeping the chest wall flat when closing it, including aesthetic flat closure and flat closure. Such operations consist of aesthetically reconstructing the chest wall through removing excess skin, fat and breast tissue after a total mastectomy. The remaining tissue is then retightened and smoothed out so the chest wall appears flat.
National Cancer Institute. (s.d.). Aesthetic flat closure. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/aesthetic-flat-closure.
External breast prostheses
There are two types of external breast prostheses:
Temporary external prostheses are fabric covered and fit into a specially designed bra. They are comfortable and can be used immediately after a mastectomy.
Permanent external prostheses are made of silicone. Since their weight and appearance are similar to natural breasts, they give your silhouette a natural shape. They can be attached directly to the chest or inserted into a pocket bra.
Tips for choosing your external prosthesis:
- Bring along a friend or relative who knows your shape and will give you their opinion.
- Compare different models and prices.
- Take your time to truly assess your options.
Breast reconstruction can be beneficial for women’s self-esteem and well-being. However, few women choose this option in Quebec (between 7% and 15%). Specialists consider breast reconstruction to be a positive option for women.
Some women do not feel the need to have their breast reconstructed. The main reasons for having breast reconstruction are:
- Replacing a lost breast
- Not having to wear an external prosthesis
- Wanting to feel more desirable and comfortable
- Wanting to forget the cancer
- Being able to vary your wardrobe (fewer limitations for bras)
You should discuss the pros, the cons and your concerns about breast reconstruction with your care team.
Breast reconstruction is surgery following a mastectomy that restores the breast to a natural appearance.
The timing of breast reconstruction depends on what treatments you have received and when you feel ready for the surgery. It can be done at the same time as the mastectomy if it does not interfere with treatment. To give the breast time to heal, it can also be done later, usually 3 to 4 weeks after chemotherapy and 4 to 6 weeks after radiation therapy. A breast can even be reconstructed months or years later if you wish.
It is important to know, however, that a reconstructed breast will never be exactly the same as a natural breast. It may feel different and the surgery may leave scars. Time will lessen these differences.
Breast reconstruction following breast cancer is covered by the Régie de l’assurance maladie du Québec (RAMQ).
Types of breast reconstruction
Breast implants are a round or teardrop-shaped shell of rubberized silicone that is filled with a sterile saline solution or silicone gel. The implant is inserted into a pocket under the chest muscles. Two techniques can be used to form this pocket: tissue expansion or tissue support.
If the skin and chest tissue is too tight or flat, the plastic surgeon may expand the tissue. This procedure involves inserting an empty sac under the chest muscles and gradually filling it with saline solution. This is done in the doctor’s office once or twice a week for up to three months. When the pocket is large enough, a second surgery is performed to remove the expander and replace it with the permanent implant.
Reconstruction with tissue support
The implant pocket can be made of special skin tissue from human donation, called acellular dermal graft (AlloDerm, DermMatrix) from which the cells have been removed. Strips of tissue are stitched to the breast tissue to create a pocket for the implant.
In the past, there have been concerns about silicone implants; however, years of monitoring has proven they are safe and do not cause harm. Very rare cases of non-Hodgkin’s lymphoma, called breast-implant associated anaplastic large-cell lymphoma (BIA-ALCL) have been reported with textured implants. Studies are underway to validate this information.
In addition to prostheses, another option is autologous breast reconstruction. This technique uses muscle and fat tissue from other parts of the body and grafts them onto your breast. This option has a more natural effect. There are two autologous breast reconstruction methods: the free flap and the pedicle flap.
The free flap is the most commonly used surgical breast reconstruction method. The tissue used to reconstruct the breast is completely removed and then connected to the blood vessels in the chest during surgery. This muscle and fat tissue is often taken from the abdomen. This technique is used when the patient has already received radiation therapy.
The pedicle-flap method removes muscle, skin and fat tissue from the abdomen, keeping it attached to the muscles and blood vessels; in other words, it is not completely disconnected. The flap is tunneled under the skin to the breast area. This technique is used when the patient has not received radiation therapy.
The areola and nipple can also be reconstructed if necessary. This procedure is usually performed after the reconstructed breast has taken its final shape, about 3 to 6 months after surgery. A reconstructed nipple is usually less sensitive than a natural nipple and the colour of the nipple and areola may differ from the other breast.