Author: Molly Lindquist
Medically reviewed by Dr. Doug Blayney on November 11, 2024.
When I first heard the words "you have breast cancer," my world stopped spinning for a moment. What followed was a whirlwind of decisions, and one of the biggest ones was choosing whether to have breast reconstruction after my bilateral mastectomy. I remember feeling overwhelmed by all the options, so I wanted to share my experience and what I learned along the way to help others facing similar decisions.
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Types of Breast Reconstruction Options
Let me tell you about the main options my doctors discussed with me. There are basically two ways to go about reconstruction:
- Using implants
- Using your own body tissue (they call this "flap reconstruction").
Implant reconstruction is what it sounds like – the surgeon places either saline or silicone implants to recreate your breast shape. I was surprised to learn that modern implants feel pretty natural! Some of my friends went this route and are really happy with their choice.
The other option, Flap reconstruction, uses tissue from another part of your body – usually your tummy, back, or thighs – to create a new breast. My friend Nancy chose this option because she wanted something that would feel more natural and last longer than implants. The advantage is that it's your own tissue, so it ages with you. The downside is that it's a bigger surgery with a longer recovery time.
Factors to Consider When Choosing Reconstruction Options
Making this decision isn't just about what looks best – there are so many things to think about. Here's what my doctors helped me consider:
- My overall health: Some options might not work if you have certain health conditions
- My cancer treatment plan: If you need radiation therapy, it might affect when you can have reconstruction
- Recovery time: How long can you take off work? Who can help you during recovery?
- What feels right for you: Some women want to look exactly like they did before, while others are okay with a different appearance
I also had to think about whether I was ready for possible future surgeries. With implants, you might need to replace them after 10-15 years. With flap procedures, you usually don't need more surgeries unless you want adjustments.
Recovery and What to Expect
I wish someone had given me the real scoop on recovery, so here's my honest experience. The first few weeks are the toughest, no matter which option you choose. You'll need help with everyday tasks like getting dressed or reaching for things. Even simple things like taking a shower required planning!
With implant reconstruction, I was in the hospital for about 2 days. The drains (small tubes that remove excess lymph fluid) stayed in for about 1-2 weeks. It took about 6 weeks before I felt somewhat normal again, though I still had to be careful with lifting things. I was pretty young when I was diagnosed, so I assumed that I’d bounce back more quickly, but that definitely wasn’t the case.
Choosing Which Type of Breast Reconstruction to Have
This is such a personal decision, and there's no wrong choice. Your body type plays a big role – for example, if you're very thin, you might not have enough extra tissue for a flap procedure. Your lifestyle matters too. If you're very active, you might prefer using your own tissue since implants can sometimes feel less natural during exercise.
The best advice I got was to take my time making this decision. I talked to several plastic surgeons, got second opinions, and even joined a support group where I could talk to other women who'd been through different types of reconstruction.
Will Insurance Cover My Breast Reconstruction?
Here's some good news – breast reconstruction is usually covered by insurance! Thanks to the Women's Health and Cancer Rights Act, insurance companies must cover reconstruction after mastectomy. This includes:
- The reconstruction itself
- Surgery to make both breasts look symmetric
- Any revisions you might need
But here's a tip from someone who's been there: call your insurance company and get the details in writing. Ask about deductibles, co-pays, and whether you need pre-approval. It saved me from surprise bills later!
Tissue Expansion and Implant
If you choose implants like I did, you will probably need tissue expansion first. Here's how it works: during your mastectomy, the surgeon places a temporary expander under your chest muscle. Every few weeks, they add a little saline solution into the expander through a tiny port under the skin. It's like slowly blowing up a balloon to stretch your skin and make room for the permanent implant. I kind of felt like I was going through puberty again, watching my chest grow week by week.
I won't sugar-coat it – expansion can be uncomfortable, especially for a day or two after each fill. But it's manageable with pain medication, and each session only takes about 15 minutes. The whole process took about 3 months for me before I got my permanent implants.
When's the Best Time to Have Breast Reconstruction?
You have two main options: immediate reconstruction (during your mastectomy) or delayed reconstruction (months or even years later). I chose immediate reconstruction because I wanted to wake up from my mastectomy already having the reconstruction process started.
But delayed reconstruction might be better if you:
- Need radiation therapy
- Want more time to think about your options
- Aren't physically or emotionally ready for a longer surgery
- Want to focus on cancer treatment first
Remember, there's no time limit – you can have reconstruction even years after your mastectomy.
How Long Does Breast Reconstruction Surgery Take?
Let me break down the timing so you know what to expect:
- Implant reconstruction with tissue expanders: 2-3 hours
- Direct-to-implant reconstruction: 2-3 hours
- Flap reconstruction: 4-8 hours (sometimes longer)
But don't forget to count prep time before surgery and recovery time in the hospital. It's like planning for a mini-trip (not going to lie, not a super fun one!) – pack a bag, bring comfy clothes, and arrange for someone to drive you home!
What Are the Possible Side Effects?
I believe in being honest about side effects because knowing what to expect helps you prepare. Here's what you might experience:
Common side effects for all types:
- Pain and soreness (especially in the first week)
- Swelling that can last several weeks
- Bruising
- Tiredness (more than you might expect!)
- Scars that fade over time
- There is a small risk of infection at the surgical site(s) for either procedure, which might require home intravenous antibiotics and more surgery
With implants, watch out for:
- A tight feeling in your chest
- Possible implant rupture (though this is rare with modern implants)
- Something called "capsular contracture" where scar tissue can make the implant feel hard
With flap procedures, you might have:
- Weakness at the donor site (where they took the tissue from) and trouble moving that part of the body – discuss with your surgeon
- Two areas that need to heal instead of one
- Longer recovery time
Join a community of people who “get it”
The Manta Cares team is composed of cancer survivors, caregivers, oncologists and nurses - so we truly understand the challenges that come with a cancer diagnosis because we’ve been there. We are here to walk with you as you go through your own cancer experience. Please don’t hesitate to reach out with any questions. We have even developed Your Cancer GPS™, a platform with disease-specific step-by-step maps to show you all the paths you might face during your cancer experience, future treatment options and connect you with relevant support and resources. Sign up for access to the Your Cancer GPS™ platform here.
Be sure to subscribe to our newsletter and check out our free resources like our Chemotherapy Checklist for Caregivers, Financial Checklist for Cancer Treatment and more. We also put out a bi-weekly podcast called the Patient from Hell to educate, empower and hopefully inspire you as you go through this crappy experience. You can listen on Spotify, Apple Podcasts, YouTube or anywhere you listen to podcasts. Dealing with cancer as a patient or caregiver can feel really lonely. Just know that you are not alone in this experience.
Also Read:
- Why Do Women Lose Breast Sensation After Mastectomy?
- Updated Mammogram Screening Guidelines for Preventative Breast Cancer Screening
- Life After Early Stage Breast Cancer: What To Expect 5 and 10 Years After Treatment
- Importance of Wearing a Compression Bra After Breast Surgery
- Life After Early Stage Breast Cancer: Your Survivorship Care Plan
- Tips for Finding Balance After Early Stage Breast Cancer
Conclusion
Looking back on my experience, I realize that breast reconstruction was about more than just physical appearance – it was about feeling whole again after cancer. Whatever you choose – reconstruction, going flat, or using external prosthetics – know that it's the right choice if it feels right for you.
Remember:
- Take your time making this decision
- Ask lots of questions
- Trust your gut feelings
- Know that you can change your mind
You're not alone in this experience. Reach out to support groups, talk to other survivors, and lean on your medical team. They've helped many women through this process and can be an incredible source of support and information.
FAQs on Best Reconstruction Options after Mastectomy
Q: Which is better: implants or natural tissue reconstruction?
Ans - Neither is "better" – it depends on your body, lifestyle, and personal preferences. Implants have an easier surgery but might need replacement. Natural tissue lasts longer but requires a bigger operation.
Q: How long does recovery take after breast reconstruction?
Ans - Usually 6-8 weeks for implants and 8-12 weeks for flap procedures, but everyone heals differently. Listen to your body and don't rush it!
Q: Can I have reconstruction if I had a mastectomy years ago?
Ans - Absolutely! There's no time limit on reconstruction. Many women wait years before deciding to have it done.
Q: What if I decide not to have reconstruction?
Ans - That's completely fine! Some women choose to go flat or use external prostheses. There's no right or wrong choice.
Q: How to decide on breast reconstruction?
Ans - Talk to your doctors, join support groups, and take time to process your feelings. The right choice is what feels best for you.
Q: Is it better to wait for breast reconstruction after mastectomy?
Ans - It depends on your situation. Immediate reconstruction means one less surgery, but waiting might be better if you need radiation or want more time to decide.
Q: What are the options for breasts after mastectomy?
Ans - You can choose reconstruction with implants or your own tissue, go flat, or use external prostheses. Each option has its own benefits.
Q: What is the most natural-looking breast surgery?
Ans - Flap procedures using your own tissue often look and feel most natural, but skilled surgeons can achieve natural results with implants too.
Q: What is the new technique for mastectomy?
Ans - Nipple-sparing mastectomy and hidden scar techniques are becoming more common, making reconstruction results look more natural.
Q: What are the best breast implants after mastectomy?
Ans - Modern silicone gel implants are most popular because they feel more natural than saline, but the "best" choice varies for each person.
Disclaimer: All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.