Breast reconstruction

2. Natural tissue flaps - This is where skin and soft tissue is taken from different parts of the body to recreate a breast that feels more natural.

3. Combination of implants and natural issue

Within these types of reconstruction surgeries, there are many subtypes. This amount of information can be overwhelming and making a choice of type of breast reconstruction may seem impossible. It is important to discuss with your surgeon what is right for you and to get a second opinion if you are unsure which surgery, if any surgery at all, you would like to go forward with. Here, we go over a breakdown of the differences between them to help you make an informed decision.

Breast Implants

As previously mentioned, breast implants can be filled with either saline or silicone. The risks and side effects are the same for both, and both will likely need to be replaced every 10 years. If you'd like to alter the implant before this time, the expander in both can change in size, however the size of the implant itself cannot be changed without surgery in either of them. The main difference between the two is the feel of the implant. Silicone implants feel more natural than saline implants.

Size

Other decisions you will have to make for your implants will be their size. The implant size will depend on a number of things from personal preferences, breast skin, cancer treatment, and the chest area after a mastectomy. You should be able to work with your reconstruction team for what size will work best for you.

Surgical placement

Once you have decided the material and size of your implants, you will decide how they are placed. If you have enough healthy skin and a large enough skin-muscle envelope after your mastectomy, then your final implant can be placed immediately as a part of the same procedure. This is usually placed under the muscle, but if the patient uses their chest muscles more often, having the implant under the muscle can cause issues, so they may want to have the implants inserted above the chest muscle.

However in most cases, something called a tissue expander will be surgically placed first. This is a saline device that is temporary and is placed between the breast skin and chest muscle. It has a valve that can be accessed from the outside of the body. Over a period of time, usually between 2 to 6 months, this skin-muscle envelope is stretched by routinely injecting saline through the valve into the tissue expander. Once the tissue expander is at the desired size for your final implant, your surgical team will remove the temporary implant (tissue expander) and replace it with the final implant. This is a second surgery, but it doesn't require a hospital stay (outpatient surgery).

Pros about breast implants

• Implants are the least invasive type of breast reconstruction surgery because tissue and skin does not need to be taken from other parts of the body.

• Breast implants can be done during the single or double mastectomy, so you would not have to have an extra hospital stay later on.

• If you do choose to have the implant surgery done later, then this would require an additional, short hospital stay, such as 1-2 days, and your recovery time would be 3-4 weeks.

• You will have less surgical scars from breast implants than you will from natural tissue flaps.

• Breast implant surgery is less likely to fail than natural tissue flap surgery.

Cons about breast implants

• Breast implants may not look and feel as natural as natural tissue flaps because they don't come from other parts of your body.

• If you only need reconstruction on one breast, it may be harder to match the implant to the real breast, especially as you age and your real breast tissue begins to drop.

• There is a chance that you will need to replace the implants later in life.

Natural tissue flaps

This method of breast reconstruction uses skin and tissue from other parts of the body to rebuild the breast(s). While natural tissue flaps will look and feel more natural, this procedure is more complex and you will likely stay in the hospital longer than you would for a reconstruction with implants. There are many types of flap reconstruction including, transverse rectus abdominis myocutaneous (TRAM), latissimus dorsi muscle, deep inferior epigastric perforator (DIEP), profunda artery perforator (PAP), superficial inferior epigastric artery (SIEA), superior and inferior gluteal artery perforator (S-GAP and I-GAP), transverse upper gracilis (TUG) and diagonal upper gracilis (DUG). You shouldn't already know what any of these mean, but they differ based on where they take the skin, tissue and muscle on the body, ranging from the tummy to the butt.

Pros about natural tissue flaps

• More natural feeling breasts than implanted breasts.

Cons about natural tissue breasts

• Because the surgery takes tissue and skin from other parts of the body, you will end up with more scars.

• Similarly, it is likely that you will stay in the hospital longer and have a longer recovery time.

• The area of your body where the skin is removed to use on your breasts may be weak afterwards. This could limit your daily activities depending on where the skin is removed from.

If you are interested in natural tissue flaps, ask your medical team which type of procedure is right for your body.

Combination of both

If you choose to do your breast reconstruction at the same time as your mastectomy, you can choose a skin-sparing mastectomy. While your nipple will still be removed, most of the skin around the breast will remain, which can either be used to cover a natural tissue flap or a breast implant. There is also a version of the skin-sparing mastectomy where the nipple is kept as well. This is called a nipple-sparing mastectomy. This procedure removes neither the nipple, nor the areola (area surrounded the nipple) from the breast. However, not everyone can have a nipple-sparing mastectomy. This will depend on the location of the cancer, type of breast cancer and the size and shape of your breasts.

What should I do if I want to still have nipples?

If you were unable to have a nipple-sparing mastectomy, but you still want to have nipples, there are options! You can get a 3D tattoo of the nipple and areola, or you can have a small surgery by using skin from your groin. This is usually an outpatient procedure, meaning that you will not have to stay overnight at the hospital. It is a good idea to get advice from your medical team as well as to check your insurance coverage before proceeding. Your medical team will be able to guide you in the right direction based on how you would like your nipples to look.

After reconstruction

While breast reconstruction methods are improving every day, a mastectomy will cause you to lose feeling in your chest, meaning that you won't be able to feel your breasts the same way you were able to before. Some of the nerve endings may heal, so there is a chance of some feeling, but there is no guarantee that the area will get sensation back.

It is natural to feel a lot of emotion about losing your breasts, and you are not alone. Connecting with support groups online or in your area may be a good tool to chat with other women about their experiences with breast reconstruction and what has helped them both physically and emotionally. Check out our Germie recommended support below.