Breast Reconstruction Surgery After a Mastectomy

Many women with early-stage cancers can choose between breast-conserving surgery and mastectomy. A small number of women having breast-conserving surgery may not need radiation while a small percentage of women who have a mastectomy will still need radiation therapy to the breast area.

Mastectomy involves removing all of the breast tissue, sometimes along with other nearby tissues. In a simple or total mastectomy, the surgeon removes the entire breast, including the nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the breast.

A modified radical mastectomy is a simple mastectomy plus removal of axillary (underarm) lymph nodes.

A radical mastectomy is an extensive operation where the surgeon removes the entire breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but a modified radical mastectomy has proven to be just as effective without the disfigurement and side effects of a radical mastectomy. Radical mastectomy may still be done for large tumors that are growing into the pectoral muscles under the breast.

For women who have a mastectomy, breast reconstruction is an option.

Do I need to have breast reconstruction?

It is never medically necessary to have breast reconstruction. This is considered an elective procedure, meaning you can choose to have it done or not. Some women choose to have a mastectomy (removal of all of the breast tissue) without reconstruction. Although it is considered elective, it is not considered solely cosmetic. Federal law mandates all insurance plans pay for breast reconstruction if a mastectomy is indicated.

Are all women candidates for breast reconstruction?

The vast majority of women are candidates for breast reconstruction. There are a variety of reconstructive options and you may not be a candidate for all types. You and your plastic surgeon will discuss which type of breast reconstruction best fits your situation.
What is the difference between immediate and delayed reconstruction?
Many patients prefer to have reconstruction done (or at least the process started) at the same time as their mastectomy for a number of reasons. If you have breast reconstruction done at the same time as your mastectomy this is called immediate reconstruction.

Delayed reconstruction is the term used if you choose to have the mastectomy done and then wait for reconstruction to be done months, or even years later. The majority of surgeries done at Penn Medicine are immediate reconstruction. With immediate reconstruction you are decreasing your overall number of surgeries, you may have a better chance at an optimal cosmetic result and for many women there is a psychological benefit to immediately pursuing reconstruction. You and your plastic surgeon will determine whether immediate or delayed reconstruction is the best option for you.

What are the major types of breast reconstruction available?

There are three major types of breast reconstruction. The first is a tissue expander implant reconstruction. The second uses all your own tissue, typically from the abdomen but the tissue can be taken from your buttock or thighs. The third, less common option is a combination of the two methods using your own tissue from the back, latissimus muscle (large muscle of the back), plus an implant underneath.