Patient Information Portal

Breast Reconstruction After A Mastectomy

By

Understanding Breast Reconstruction After A Mastectomy

Having a mastectomy (whether for treating breast cancer or as a preventive measure) can be a life-changing experience. The breast is often closely tied to a woman’s sense of identity and femininity, which is why many women choose to have breast reconstruction to restore their physical and emotional well-being.

There are two main types of breast reconstruction:

  1. Implant Reconstruction: Uses materials like silicone implants to recreate the breast shape.
  2. Autologous Tissue Reconstruction: Uses your own body tissue (like skin, fat, and muscle) to rebuild the breast.

Both options have their pros and cons, and the best choice depends on individual factors, including health, personal preferences, and surgical recommendations. There’s no one-size-fits-all solution.

Comparing Complication Rates

A study published in JAMA Surgery titled “Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction” looked at 2,343 patients to compare complication rates between implant and autologous reconstructions:

  • Overall Complication Rate: 33% for both types combined
  • Re-operation for Complications: 19% of patients
  • Wound Infections: 10% of patients

For comparison, a simple mastectomy without reconstruction typically has a 1-5% risk of wound complications and a 1-2% risk of needing another surgery.

Key Findings:

  • Autologous Reconstruction had higher rates of complications, re-operations, and wound infections compared to implants.
  • This is likely because autologous surgery is more complex and takes longer to perform.
  • There are additional risks related to the donor site (where tissue is taken from), such as the abdomen in procedures like the TRAM flap, which can lead to issues like bleeding or wound infections.

But Complications Aren’t the Whole Story…

While autologous reconstruction has higher initial complication rates, that doesn’t mean it’s a worse option. In fact, it might offer better long-term results.

A second study from JAMA Surgery, “Long-term Patient-Reported Outcomes in Post-Mastectomy Breast Reconstruction”, looked at 1,217 women and measured their satisfaction using the BREAST-Q questionnaire.

What Did They Find?

  • Women who had autologous reconstruction reported higher satisfaction with the look and feel of their breasts two years after surgery.
  • They also experienced better emotional well-being and improved sexual well-being compared to those with implants.

Short-Term vs. Long-Term Outcomes

  • Autologous Reconstruction:
  • More complex surgery with higher initial complication rates
  • Better long-term satisfaction with the look and feel of the breast
  • Less need for additional surgeries over time
  • Implant Reconstruction:
  • Less complex surgery with fewer early complications
  • Good short-term results, but implants may not age as well as natural tissue
  • Higher likelihood of revision surgeries (like implant replacement) after 10-15 years

Which Option Is Right for You?

There is no single best option for breast reconstruction. The decision depends on many factors:

  • Your health and medical history (e.g., cancer treatment, radiation therapy)
  • Personal preferences and how important certain outcomes are to you
  • Long-term expectations for how your breast will look and feel
  • Your surgeon’s experience with different techniques

Most importantly, you deserve to have all the information you need to make a decision that feels right for you. Take your time, ask questions, and discuss your options with your medical team.

Learn More

For more information on breast reconstruction after mastectomy, visit the National Cancer Institute’s website.

Breast reconstruction is a personal journey. No matter what path you choose, it’s about finding what feels best for you and your well-being.