Common Questions to consider before your consultation with your Plastic Surgeon:

• I only have cancer on one breast and only want a mastectomy on this one side. Which reconstructive option will best match my other breast?

  • When only having mastectomy and reconstruction on one side, it is possible to have a “balancing” procedure on the other side. Your breast shape, size, fullness and the amount of droop will determine how best to match your reconstruction.

  • If having an “autologous” reconstruction for example, using your abdomen, your reconstructed breast will have a more natural feel than an implant, and will also grow or shrink with weight gain and loss. Your other breast may not need any surgery to best match the reconstruction, but in some cases may benefit from a reduction or a lift.

  • If you have implant-based reconstruction, the implant often creates a more full upper border of the breast. Depending on the shape and fullness of your other breast, an implant on the other side may help to match the reconstruction, or in some cases a breast lift is sufficient.

  • When meeting with your surgeon, it is advisable to first decide on your care and plan from the mastectomy and reconstruction for your affected side, and then use this to guide your plan for the other breast.

• Will reconstruction interfere with my radiation or chemotherapy?

  • The treatment of your cancer is of foremost importance in your treatment. If your oncology team have determined that you will certainly need radiation after your mastectomy, then it may be advisable to delay reconstruction until radiation and/or chemotherapy are complete in order to minimize complications from the reconstruction.

• How long with the surgery take? How long will I be in the hospital?

  • This depends on a few factors, including whether you have immediate (at time of mastectomy) or delayed (some time after mastectomy) reconstruction, and whether you have implant or autologous tissue (flap)- based reconstruction.

  • Autologous reconstruction most often refers to the transfer of abdominal tissue (flap) from your abdomen for your breast reconstruction. This requires reattaching the blood vessels from the abdomen to those in the chest in order to supply the flap. This technique is called microsurgery. These operations are usually much longer that implant based reconstruction, and average 5-7 hours for one side, and about 8-10 hours for both sides. Typically you will be in hospital for 4-5 days after surgery.

  • Implant-based reconstruction does not require microsurgery and therefore requires less time in the OR. Most often, this is 2-3 hours, but may be somewhat longer if it is being done at the same time as the mastectomy. Typically, you will remain in hospital overnight following your procedure and go home the next day.

• When will I be able to return to normal activities such as driving, working, and exercising?

  • For implant-based: Usually 4-6 weeks before resuming activities.

  • For autologous reconstruction: Approximately 6-8 weeks.

• What will my breasts look like after reconstruction? What results are realistic for me?

  • The final appearance of your breast reconstruction depends on many factors, including:

    • The thickness of the skin and tissue that remains after your mastectomy.

    • The appearance of your breast prior to surgery

    • Whether you have had radiation

    • Implant vs Autologous reconstruction

• What will the feeling/sensation be in my reconstructed breast?

  • You will not have much feeling to the breast/chest wall after mastectomy, with or without reconstruction. This is because the sensory nerves to the skin are cut during the removal of the breast tissue. Some women do get some improvement of this over time.

• What kinds of changes to the breast can I expect over time with ageing and gaining or losing weight?

  • For autologous reconstruction, the new breast tissue consists of abdominal fat cells. As such, if you gain and lose weight, your reconstructed breasts will also grow or decrease in size. With time, as with all tissue, your reconstructed breasts will begin to descend, or sag, slightly.

  • For implant based reconstruction, the implant also tends to descend somewhat with time as the skin stretches with gravity.

• Is there a surgery that I am not a candidate for? What reconstruction is best for me?

  • Most often, there is an option available that will be suited to you for reconstruction. In general, if you are medically not well enough to tolerate a prolonged anesthetic, you would not be a good candidate for autologous reconstruction (flap reconstruction).

  • If you have previously had radiation, the rate of complications is significantly higher (4 times higher) for implant-based reconstruction, and therefore autologous may be advisable.