March 4, 2011
Dear Mayo Clinic:
I am considering breast reconstruction after my mastectomy. What things should I consider? Will I have the same breast size and shape I had before?
Many factors should be considered when deciding on breast reconstruction following a mastectomy. This very complex topic has a wide range of variables based on your individual circumstances and preferences. The best way to make an informed, thoughtful choice about breast reconstruction is by working with the members of your health care team to learn as much as you can about your options, sort through all the details, and decide what's right for you.
Because breast reconstruction is an optional procedure that's done for personal reasons, it's important to carefully consider your preferences when deciding whether to have the surgery. For example, age is a consideration for many women. Younger women tend to have reconstruction after mastectomy more often than women who are older. Activity is also an issue that many women take into account. If you are active and enjoy hobbies like running, swimming or biking, breast reconstruction may be a better fit for your lifestyle than a prosthesis.
In addition, breast size may be a consideration. If you have large breasts, it may be difficult for reconstruction to match your other breast. Some women in this situation opt to have surgery on both breasts, so the size is comparable on both sides. The size and shape of your breasts after surgery depends heavily on their appearance prior to reconstruction. Some breast shapes are easier to reconstruct than others.
These are just a few examples of the many factors you need to consider before having breast reconstruction. But you don't have to figure it out by yourself. Ask your doctor about resources that are available to help you learn more. Many health care facilities have professionals who specialize in educating women about breast reconstruction.
For example, at Mayo Clinic, women considering reconstruction meet with a nurse educator who has expertise in breast health. Together, they discuss topics including the surgical options, risks, recovery time and results. Before you make a decision you should have a detailed consultation with a plastic surgeon about your situation, so you can find out what's appropriate for you.
In some cases, reconstruction may depend on your cancer treatment plan. For example, if you will be having radiation therapy following your mastectomy, that may make breast reconstruction more complicated, but not in all cases. Your surgeon can help you decide how best to proceed.
Because breast reconstruction is such a complicated issue, women in your situation can benefit from seeking care at a medical facility where specialists from different areas can easily collaborate. That way, your oncologists, surgeons and other members of your health care team can work together to develop a unified treatment plan.
Collaborative multispecialty care is also preferable because having breast reconstruction immediately following mastectomy has been shown to provide the best results. But to do the procedures one after the other requires coordination between the surgeon who will be performing your mastectomy and the plastic surgeon who will be doing the reconstruction.
Finally, don't rush it. When facing a diagnosis of breast cancer, many women — understandably — feel a sense of urgency to move forward quickly. In most cases, however, taking several weeks to learn about your options and carefully consider the possible outcomes of your decisions will not have a harmful effect on your long-term health.
Breast reconstruction does not have a one-size-fits-all solution. Take time to think about what you want. Talk to your health care team about what will work for you. Make sure you understand what will happen and are comfortable with it. Then, move forward.
— Paul Petty, M.D., Plastic Surgery, Mayo Clinic, Rochester, Minn.