We’re not doctors and we don’t provide medical advice, but I can tell you what we know based on research and from speaking with many experts and with women who have had breast implants.
If you have been diagnosed with early stage breast cancer (stage I, IIa, IIb, or IIIa) , you may be able to keep your breasts, and have a lumpectomy rather than a mastectomy (which removes the entire breast). Studies show that early-stage breast cancer patients who undergo a lumpectomy (which removes only the cancer and a small area around it) and radiation will likely live just as long as women who have a complete mastectomy.
If you have been diagnosed with a pre-cancerous condition such as Stage 0 breast cancer, including ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS), it is unlikely that you need a mastectomy. Women with LCIS do not have breast cancer and most will never get breast cancer, though they do need regular mammograms.
Breast Reconstruction Options after Mastectomy
If a woman needs to have a mastectomy, there are several choices for reconstruction. Many breast surgeons and breast cancer patients believe that breast reconstruction is an important step in recovering physically and mentally from a mastectomy.
Breast implants are the most common form of breast reconstruction after mastectomy. This is probably because breast implants are the easiest form of reconstruction and most plastic surgeons are not skilled enough to perform the other types of breast reconstruction discussed below. There are silicone gel breast implants and saline breast implants on the market, and both options have a high complication rate for reconstruction patients. Some of the most common complications of breast implants include implant rupture, capsular contracture (painful hardening and abnormal shape of the breast), breast pain, autoimmune symptoms, and interference with mammography for breast cancer screening. In addition, women who have breast implants, either for mastectomy or healthy breasts, are more likely to develop a type of lymphoma (cancer of the immune system) called ALCL.
An alternative to breast implants is autologous tissue transfer (also known as a flap or flap procedure), where the body’s own tissue is used to reconstruct breasts. There are various types of autologous tissue transfer.
Flap reconstruction with muscle and fat, also called the TRAM flap, uses muscle and fat from the abdomen. Reconstruction methods using fat and muscle create a more natural looking reconstruction than those using only fat due to their added firmness. Also, the larger amount of tissue used during muscle and fat reconstructions enables the surgeon to create larger breasts than those with fat only.
Surgeons can also perform flap reconstruction with fat only, also called the DIEP Flap, which takes skin, vessels, and fat from the abdomen. Surgeons can take tissue from most areas of the body that have a large fat supply. Reconstruction with only fat takes more time than other procedures because the tissue has to be harvested and removed from the body before the reconstruction can take place. To be a good candidate for this procedure, women need more body fat to create the breast.
The last option for flap reconstruction is commonly called the Lat Flap, and uses the latissimus dorsi (upper back muscle) to reconstruct breasts. This procedure is more likely to fail than some other flap procedures, but less likely to have surgery-related complications or need reoperations within the first two years. However, since the latissimus dorsi is a large and important back muscle, the procedure can lead to serious difficulties moving, lifting, or performing strenuous exercise.
The decision of which reconstruction option to choose, if any, is a personal one. To make an informed choice, however, patients need to meet with breast surgeons who are skilled at the different options. Since most breast surgeons only know how to do reconstruction with breast implants, they don’t usually provide good information to their patients about the benefits of other options. You can read more about each of these options for breast reconstruction here.
All articles are reviewed and approved by Diana Zuckerman, PhD, and other senior staff.