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Breast Reconstruction and Prosthesis

Body image is about more than your physical self. It can include your overall sense of wholeness, how you feel about yourself, your body and your appearance, as well as how you relate to others. For many women, their breasts play an important role in their body image, and how they feel about their bodies and as a woman.

Having a mastectomyMastectomy:
Surgery to remove all or part of the breast and sometimes other tissue.
leads to a significant change in physical appearance. If a mastectomy is part of your treatment plan, you may wish to discuss your options for breast reconstruction or prosthesisProsthesis (breast):
An artificial breast form that looks like a breast and is worn either inside a bra or attached to the body with special adhesive.
with your health care team.

You may also choose not to take action to restore or change the appearance of your breasts. Only you can decide which option is right for you.

Breast Reconstruction

In breast reconstruction, a surgeon performs an operation to create a new breast(s). Your appointment with a breast reconstruction surgeon can occur before or after your mastectomy and they will discuss all of your options with you, both surgical and non-surgical.

Timing

Breast reconstruction can occur at the same time as having a mastectomy (immediate breast reconstruction) or at a later time (delayed breast reconstruction). The options available to you will depend on a number of factors, including the type of breast cancer, the size of the tumourTumour:
An abnormal mass of tissue that occurs when cells divide more than they should or do not die when they should. Tumours may be benign (not cancer) or malignant (cancer). A tumour is also called a neoplasm.
, whether you are having radiation therapyRadiation therapy:
(Sometimes called radiotherapy) A treatment method that uses a high energy beam to destroy cancer cells by damaging the DNA of cancer cells so that they can’t continue to grow.
after your surgery, and whether your hospital or breast center offers immediate reconstruction. Delayed breast reconstruction can be done months or years after a mastectomy, once the area has healed and your breast cancer treatment is complete. It is important that breast reconstruction not get in the way of your treatment for breast cancer.

Types of Breast Reconstruction

There are several types of breast reconstruction, including the following:

If you decide on breast reconstruction, the type and the timing of surgery you have will be decided by you and your surgeon based on your needs, your body and your treatment for breast cancer. Having breast reconstruction will not affect your treatment or post-treatment follow-up care for breast cancer.

Surgery by Implant

An implant is a medical device that is filled with silicone gel or saline. Through an operation, the implant is placed under the chest tissues to create a breast that approximates the desired shape and size.

If needed, a tissue expander is used to stretch the skin before the implant is inserted. A tissue expander is an empty balloon-like device that is surgically inserted. Over the course of 2-3 months, the device is inflated over time and expands until it reaches the desired shape and size. It may then be replaced with a more permanent silicone gel implant.

The surgery time for breast reconstruction with implants is about 1-2 hours. In most cases, getting breast reconstruction is considered day surgery, and you will be able to return home the same day. The recovery time for this type of surgery is approximately 2-3 weeks for the incisionIncision:
A cut made into the skin or other body tissue as part of a medical procedure or surgery.
to heal and 6 weeks before you can go back to full activity.

Surgery with Your Own Body Tissue

In breast reconstruction using your own tissue, some skin and fat are taken from another part of your body, usually the abdomen, back or buttocks. There are different techniques for creating a new breast. This method often does not require any silicone or saline-filled devices.

Breast reconstruction surgery that uses body tissue takes more time than implant surgery. It can take from 2-8 hours for one breast depending on the tissue and the procedure being used. After surgery, you may need to stay in the hospital for a few days. Because this type of surgery is more complex, the recovery time is longer, but you should be able to resume normal activities within about 2 months.

Reconstructing the Nipple

Once your breast has been reconstructed, it is possible to undergo a procedure to reconstruct a nipple. A new nipple can be formed from a bit of skin from the breast or another part of the body. A tattoo procedure can be used to darken the reconstructed nipple and areola. The new nipple(s) will not have the sensation of a natural nipple.

You may be wondering how your breast(s) will look after reconstruction surgery. A reconstructed breast will not look exactly like your original breast, and you may wish to have the other breast resized or reshaped to match. There have been significant improvements in the techniques used in breast reconstruction surgery, however, resulting in the ability to create more natural-looking breasts. You may also be wondering about your options if you have had breast conserving surgery (e.g. a lumpectomyLumpectomy:
Surgery to remove a breast tumor and a small margin of surrounding normal tissue.
). While most women don’t notice a big difference in the way their breasts look after a lumpectomy, there are surgical options available to improve the shape of the breast.

Breast reconstruction is considered elective surgery (not an emergency surgery), so you can take time to make a decision about what action, if any, you wish to take. For some women, breast reconstruction enhances their confidence and self-image after a mastectomy. Others may not want more surgery after breast cancer treatment. Speak to your health care provider about the benefits, limitations and side effects of breast reconstruction surgery. Consider other options too, including breast prosthesis—or taking no action.

Breast Prosthesis

A breast prosthesis is an artificial breast form that looks like a breast and is worn either inside a bra or attached to the body with special adhesive. The choice to wear a prosthesis is yours. This decision usually takes place after the side effects from surgery and radiation therapy have passed.

A prosthesis may be the preferred option for women who do not want to have the surgeries that are required for breast reconstruction, or who want to take time to decide what is right for them.

Prostheses come in a range of sizes, shapes and materials that are designed to simulate the weight, feel and shape of a natural breast. If your entire breast has been removed, you may choose to wear a full prosthesis. If part of your breast was removed, you may choose to wear a partial prosthesis. You can also have a custom prosthesis made just for you.

There are many medical supply or specialty stores where you can buy a breast prosthesis. Some of these stores also sell special underwear and bathing suits with pockets stitched inside them to hold a prosthesis. Look for a vendor who has staff trained to fit breast prostheses. Be sure to ask the staff person who fits you about what to expect when wearing a breast prosthesis, how to manage it when you’re being physically active, and how to care for your prosthesis.

Speak to your health care team for advice on when to obtain a prosthesis, where from and how to access funding to help pay for the cost of it.

Finding Ways to Take Care of Yourself

Whether you choose breast reconstruction surgery, prosthesis, or not to take any action after having breast cancer surgery, it’s important to find ways to take care of and feel good about yourself.

  • Give yourself time to come to terms with how your body has changed and how you feel about it. If you can, talk to supportive and trusted friends and family about your feelings.

  • Pay attention to the rest of your body and physical appearance in a way that makes sense to you. Try self-care activities such as giving yourself a foot or hand massage, stretching or doing some simple yoga, getting a haircut, giving yourself a facial (see our resources section for do-it-yourself recipes), or painting your nails. Explore new styles of clothing that help you feel comfortable. Consider cleaning out your closet and doing a clothing exchange with friends.

  • Enjoy physical activity on a regular basis. It can be as simple as connecting with one or more friends who like to walk regularly. You may also consider joining group activities at a local community centre or joining a fitness/recreation centre such as the YMCA. If you have not been active before, begin slowly and set a goal or a target so you have something to work toward, but always check with a health care provider before starting. The camaraderie of a group can provide important support and help boost your confidence.

  • If you have friends who have had a similar experience, ask them what helped them. Informal sources of support and talking to someone you trust can be invaluable.

  • If you are struggling with your body image, consider professional counselling or peer support. In some cases, these services may be paid for by your provincial health care plan or an employee benefits plan that you may have available through work. If your workplace has an employee assistance program, they may provide short term counselling at no cost. Many communities have options for lower cost or sliding scale therapeutic support services based on your income level. You can find out what counselling resources exist in your community by asking your health care team.

If you are considering breast reconstruction surgery or prosthesis, speak with your health care team. They can provide you with education and support to help you make a decision that is right for you.


Sources:

Canadian Breast Cancer Foundation-Ontario Region & Princess Margaret Hospital. (2010). Getting Back on Track. Life after breast cancer treatment. Toronto, ON: Canadian Breast Cancer Foundation.

Canadian Collaboration on Breast Reconstruction (2014)