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Women who are facing surgery to treat breast cancer have choices when it comes to the type of breast reconstruction available to them. We sat down with Dr. Mitchell Brown, one of North America’s leading plastic surgeons, to break down those options and explain what women need to know before they proceed with this operation.

What is breast reconstruction?

Breast reconstruction, in Canada, is a medically covered procedure that involves several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. It’s not a one-size-fits-all procedure, however—the type of reconstruction will be decided by the patient or surgeon depending on particular needs, anatomy, and previous treatments. Most women who are having or have had a complete or partial mastectomy are candidates for breast reconstruction.

While breast reconstruction rebuilds the shape of the breast, it doesn’t restore sensation to the breast or the nipple. Over time, the skin over the reconstructed breast can become more sensitive to touch, but it won’t be exactly the same as it was before surgery.

What are the methods of reconstruction?

    1. reconstruction using implants
    2. reconstruction using the patient’s tissue only (‘autologous’ reconstruction)
    3. reconstruction using the patient’s tissue combined with an implant

According to Dr. Mitchell Brown, fat grafting or fat injection from one area of the body to the breast is very common today in breast reconstruction, to refine the shape of a breast once it’s been reconstructed, and to contour edges and make the breast look even more natural than it can in its first procedure.

It is also an option to not have reconstruction. Some women choose to go breast-free, use a pop-in breast form, or wait and get breast reconstruction in the future. Women should keep in mind that reconstruction at the time of mastectomy generally produces better cosmetic results than a reconstruction done much later. Still, it’s important to note that having reconstruction much later on is possible.

Recovering from a mastectomy with no reconstruction is generally easier than recovering from mastectomy with reconstruction. For women who have immediate reconstruction, the recovery time is longer than it is with no reconstruction. Depending on the type of procedure there may be some muscle weakness and/or mobility issues as well, although some of the newer flap procedures minimize this risk by preserving the muscle structure at the tissue donor site. Generally, immediate reconstruction does lead to the most cosmetically pleasing results.

Barriers and awareness

In Canada, only about 16 per cent of women who undergo a mastectomy get breast reconstruction surgery. For years, access to the procedure was limited, especially to those living in rural areas, by a lack of access to plastic surgeons. Dr. Brown saw the urgent need for improved breast reconstruction education, awareness and access, and in 2011, started BRA (Breast Reconstruction Awareness) Day. It’s an initiative that promotes education, awareness and access for women considering post-mastectomy breast reconstruction. BRA Day was created to “Close the Loop on Breast Cancer” – to educate patients about their choice for reconstruction when undergoing mastectomy, and to ensure adequate access for reconstructive surgery!

The ability to immediately offer reconstruction is now one of several quality metrics used to evaluate cancer care. There is also the pressure to make decisions quickly so that the initial breast reconstruction surgery can take place at the same time as the cancer is removed. That means less overall surgery for a patient who chooses reconstruction.

Health Canada recommendations

If you have breast implants, speak with your surgeon or healthcare professional about which type of breast implant you received. You can find some helpful information on the risks associated with breast implants, including the risk of BIA-ALCL, by visiting the breast implant section on Canada.ca. Conduct regular breast self-exams and see your healthcare professional for periodic follow-up. If you experience unusual changes to your breasts, including breast pain, sudden swelling, or a lump, consult a healthcare professional. Removing your breast implants is not recommended if you do not have any signs or symptoms suggesting BIA-ALCL. Patients should discuss the risks and benefits of removal with their healthcare professional.

If you are considering getting breast implants, you are encouraged to get more information and to discuss the risks and benefits with a healthcare professional. If you do decide to get breast implants, have a conversation with your healthcare professional about which type of implant is the best choice for you. You can find some helpful information about breast implants, including what you should ask the surgeon, by visiting the breast implant section on Canada.ca.