Which is Better: Mastectomy and Reconstruction or Two Separate Procedures?

Breast cancer is the most common cancer-related death in women after lung cancer. It is also one of the most commonly diagnosed cancers in American women, second only to skin cancer.

Battling cancer is hard, but having breast reconstruction surgery can make it harder. This struggle leaves many women unsure if they should have breast reconstruction in conjunction with their mastectomy or as a separate procedure.

Though you should consult with your doctor regarding what decision is best, the following information may to provide some insight as to which course of action may be right for you.

When to Consider Breast Reconstruction

To some women, losing one or both breasts isn’t a big deal. They mourn the loss and move on. For others, it has a profound effect on their emotional and mental state. This can lead to depression, anxiety and lowered levels of confidence.

Most women who had mastectomy are good candidates for breast reconstruction. The decision to have reconstruction surgery, and which kind to have, comes down to the patient’s needs and their doctor’s recommendations.

Here are some of the advantages and disadvantages of breast reconstruction to keep in mind as you consult with your doctor.

Advantages of Breast Reconstruction

  • Your breasts may feel more balanced (weight and look).
  • You may feel more normal in and out of clothes.
  • You may feel more feminine and attractive.
  • You may be less likely to think about your battle with cancer.
  • Breast reconstruction does not impede monitoring for cancer down the road.
  • You will not need to wear a breast prosthesis.

Disadvantages of Breast Reconstruction

  • Regardless of the type of reconstruction used, your new breast(s) will never look exactly as they did before cancer.
  • You won’t know how the reconstruction looks until you’ve fully healed.
  • Your new breast(s) will feel different.
  • If reconstruction is only one side, you may need additional procedures to make your original breast look more like your reconstructed breast.
  • Breast reconstruction cannot restore the permanent feeling loss after a mastectomy.
  • You subject yourself to risks associated with any surgery.
  • Breast reconstruction can be expensive without insurance.
  • You will take longer to heal and may need to take more time off work.
  • You may have more scars than you would have had otherwise.
  • In rare cases, complications like infection, hernias, or ruptured implants can occur years after reconstruction.

Types of Breast Reconstruction

There are two types of breast construction surgeries: breast implants or tissue flap reconstruction. In some cases, your plastic surgeon may combine these procedures for more desirable results. They may also recommend multiple procedures to reconstruct your breast(s), nipple, and areola.

You need to understand the differences between implants and tissue reconstruction so you can make the best decision. Below is a brief overview of both types of breast reconstruction.

Breast Implants:

  • Prosthetic breast filled with saline or silicone and implanted under existing skin
  • Less likely to look and feel like a natural breast
  • Some sensation loss in breast
  • Shorter and less extensive surgery
  • 1 to 2 night hospital stay
  • Implants may need to be replaced
  • Fewer scars
  • 3 to 4-week recovery time

Tissue Flap Reconstruction:

  • Reconstruction of the breast using skin, fat, and muscle from another part of the patient’s body
  • More likely to look and feel like a natural breast
  • Some sensation loss in breast and tissue donor site
  • Longer and more extensive surgery performed by microvascular surgeons
  • 3 to 4 night hospital stay
  • Tissue flaps do not need to be replaced
  • More scars
  • 4 to 6-week recovery time

Deciding When to Schedule Your Breast Reconstruction

Once you and your doctor decide which reconstruction is right, you have to decide when to have surgery. Some women do their reconstruction while they have their mastectomy and some don’t. This choice is personal but can be based on whether cancer treatment will continue after the mastectomy.

Most patients have three options when it comes to scheduling their reconstruction surgery: immediate, delayed or staged reconstruction.

Immediate breast reconstruction is performed at the same time as a mastectomy. Immediately after your natural breast is removed, a plastic surgeon begins reconstructing it, either with implants, tissue flaps, or a combination of both. In many cases, most of the reconstruction can be performed in one operation.

Immediate reconstruction is a good choice for patients who do not need further cancer treatment or those having a prophylactic (preventative) mastectomy.

Delayed breast reconstruction is done 6 to 12 months after a mastectomy but can be performed years later if desired. It is delayed to allow patients who need to continue radiation, chemotherapy, or targeted cancer treatments. These treatments can cause the reconstructed breast to lose volume and/or change color, texture, and appearance.

Delayed breast reconstruction is for women who are unsure if they want reconstruction or not. It gives them time to experience what it’s like to “go flat” or experiment with wearing a breast prosthesis. Since it can be scheduled at any time, delayed reconstruction gives women time to make the decision they feel is best.

Staged breast reconstruction, also called delayed-immediate reconstruction, is done by performing partial reconstruction during mastectomy and finishing reconstruction at a later date. During the mastectomy, the surgeon will place a balloon-like device called a tissue expander under the chest muscles. The device is left in during any remaining radiation or chemotherapy treatments and is filled with a salt-water solution to preserve the breast’s skin and natural shape.

After treatment is completed and the tissues have been allowed to heal for 4-6 months, the tissue expander is removed and the breast is reconstructed using the flap technique or implants.

A staged breast reconstruction is a great option. It allows those who need more treatment time to do so. At the same time, it also provides those who don’t need additional treatment with more options.

Delayed vs. Immediate vs. Staged Reconstruction

Many patients struggle with deciding when to have their reconstruction performed. We’ve laid out the pros and cons of each type of reconstruction to help you make this difficult decision.

Pros of Delayed Reconstruction

  • More time to focus on treatment
  • More time to research reconstruction
  • Additional cancer treatments won’t affect the reconstruction site
  • It gives patients more time to cope with losing their breast(s)

Cons of Delayed Reconstruction

  • Living without your breast(s) can be emotionally trying
  • Having another surgery or multiple surgeries can be stressful
  • Reconstruction can be more difficult due to scar tissue formation
  • Results may not be as optimal as those seen in immediate reconstruction
  • You may go through two periods of emotional adjustment (one to mourn the loss of your breast(s) and one to accept the reconstructed breast(s))
  • It may not be an option if you are a smoker, have high blood pressure, or have certain pre-existing medical conditions

Pros of Immediate Reconstruction

  • When you wake up from your mastectomy, your reconstruction will have started
  • You won’t have to see what your body looks like without your breast(s)
  • It can, in some cases, prevent the patient from being under anesthesia multiple times for additional surgeries
  • It may provide better cosmetic results than a delayed surgery
  • Does not affect the rate of cancer recurrence
  • Does not affect the ability to detect cancer recurrence
  • Reconstruction is easier because your body has not generated scar tissue
  • Your breast skin can better maintain its original size and shape

Cons of Immediate Reconstruction

  • Mastectomy surgery will last longer with reconstruction
  • Recovery will take longer than it would have had you only had a mastectomy
  • If you need cancer treatments in the future, your reconstruction could be compromised
  • It may make it harder for your surgeon to identify skin problems associated with mastectomy
  • Depending on where incisions are made, you may have more scar tissue than you would with just a mastectomy

Pros of Staged Reconstruction

  • Because the tissue expander preserves the breast skin and shape, the results you achieve with later reconstruction surgeries may be more symmetrical and natural looking
  • Additional cancer treatments can continue with the tissue expander in place
  • You and your surgeon can be sure that your cancer is in remission before finishing reconstruction 

Cons of Staged Reconstruction

  • The process of reconstruction must continue with several small revision surgeries
  • “Matching” surgeries may be required to make your natural breast look more like your reconstructed breast
  • Cancer treatment may take longer to complete
  • Your breast(s) will not look natural with the tissue expander in place

Making the Right Choice for You

There are a lot of factors that influence your decisions on breast reconstruction, including:

  • Your overall health
  • Natural breast size
  • The size, location, and stage of your cancer
  • The effects reconstruction may have on other body parts
  • Whether you need additional cancer treatments or not
  • How much time you can take off work/away from other duties
  • How quickly you’d like to recover
  • Surgical costs
  • Insurance coverage
  • Whether you really want breast reconstruction or not
  • Your desire to feel “normal” after a mastectomy
  • The amount of extra tissue available (if opting for tissue flap reconstruction)

We know how stressful it can be to think about breast reconstruction when you’re fighting cancer. At The Centre, P.C. we will do whatever we can to make this difficult time easier for you and your family. Our plastic surgeons work with you and your oncologist to determine which kind of breast reconstruction meets your needs.

If you’d like to learn more about breast reconstruction options available at The Centre, P.C. call us at 574-621-3141 or contact us through our website to schedule a free consultation.

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Meet the Doctors
Dr. Downs
Dr. Downs

Ronald K. Downs, M.D., F.A.C.S. founded The Centre, P.C. in Elkhart, Indiana in 1992. He is an active member in the American Society of Plastic Surgeons. Dr. Downs is also a member of The American Society for Aesthetic Plastic Surgery, The American Medical Association, The Ohio Valley Plastic Surgery Society, The Rush Surgical Society, and The Indiana State Medical Association where he serves on the board of directors and has served as the president from 2003 to 2004.

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Dr. Viscardi
Dr. Viscardi

Patrick J. Viscardi, M.D. has been part of the surgical team at The Centre, P.C. since 1998. Dr. Viscardi graduated from Dartmouth College in Hanover, New Hampshire, as a summa cum laude. He received his Doctor of Medicine Degree from the University of Rochester in New York. Dr. Viscardi completed his internship and general surgery residency at the University of Louisville, where he served as chief resident from 1994 to 1995.

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