Making Choices Around Breast Reconstruction Surgery

Breast cancer patients face a dizzying number of choices for breast reconstruction after mastectomy. A Michigan Medicine plastic surgeon offers advice and insight.

Breast reconstruction after mastectomy can have long-lasting effects on quality of life.

But with multiple options available, each with its own risks and benefits, the decision process can be overwhelming.

"Thanks to treatment advances, most people survive breast cancer, which is the good news," says Michigan Medicine plastic surgeon Ed Wilkins, M.D.

But as Wilkins learned firsthand after his mother endured breast cancer treatment, many patients don't receive proper guidance in learning about reconstruction types -- as well as the physical and mental implications that may arise.

It's why Wilkins gathered a group of researchers to conduct the largest study on patient-reported outcomes after breast reconstruction surgery. The comprehensive study looked at patients’ pain, complications, fatigue, physical functioning, satisfaction and general well-being.

Still, the decision to choose reconstruction is ultimately a personal one.

"If a patient is happy, that is the most important outcome," says Wilkins. "What is most important is that you make the best choice for you. Don't let the expectations of other people make that decision."

He offered some key takeaways for women.

Michigan Medicine plastic surgeon, Adeyiza Momoh, M.D., discusses breast reconstruction.
Read/download the Breast Reconstruction transcript.

Tips for breast reconstruction patients

Talk to a plastic surgeon.

If you're considering mastectomy, arrange time to speak with a plastic surgeon -- even if you think you don't want to have breast reconstruction. Wilkins urges women to ask questions during this meeting.

"You want to make sure you're basing this decision on the requisite amount of knowledge so you can make a fully informed decision," Wilkins says. "This is important. Ask how the operations would impact your daily life."

You don’t have to choose reconstruction.

Unlike cancer treatment itself, breast reconstruction is not required. Some women choose not to reconstruct their breast after mastectomy.

In fact, a whole movement has grown around the idea of “going flat” after mastectomy.

Nor must reconstruction occur right away: "One of the findings from our study is that a delayed reconstruction is just as successful and satisfying as an immediate reconstruction," Wilkins says.

There’s no one single best option.

There are two main types of breast reconstruction: those involving saline or silicone-gel implants, and those that use a patient’s body tissue -- a choice known as a flap procedure.

After six years and surveying nearly 3,000 patients in the study, Wilkins says the results did not find one single best route in terms of patient satisfaction and risks.

Generally, those who had one of several types of flap reconstruction had a higher risk of complications than those who had breast implants. Flap reconstruction patients were significantly more satisfied with their breasts and breast-related quality of life.

"Different options fit different people, and this isn't an easy decision," Wilkins says. "What this says to me is patients should be as informed as possible, and work with their surgeons to find the best option for them."

Expect to have more than one operation.

The prevalence of this notion surprised Wilkins and his research team.

"What became abundantly clear is that regardless of which operation a woman chooses, she is usually facing more than one operation," Wilkins says.

“Not even the operations sold as ‘one and done’ can guarantee that there won’t be follow-ups to contour the breast, alter the other breast to match, or do nipple reconstruction."

Multiple surgeries won’t necessarily affect patient satisfaction, Wilkins notes, but the complication is important to consider.

Weigh all risks and benefits.

When choosing a reconstruction operation, or even choosing whether or not to undergo reconstruction, it’s important to weigh all the risks and benefits.

Close to a third of women who had breast reconstruction had some kind of post-surgical complication, the study found. Some were as minor as a wound that took extra time and antibiotic ointment to heal; others involved follow-up surgery to address a complication.

"We did find that complications are fairly common, especially in immediate reconstruction," Wilkins says. "But though complications on all reconstruction methods are common, failure is relatively rare."

I always tell my patients that the road to reconstruction may be long at times, and it may be bumpy. But if people stick with it, they usually get where they want to go."

Breast reconstruction may not be for everyone, but the study showed that regardless of the type, it offers significant benefits and quality of life improvements for the women who choose it.