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Breast reconstruction after mastectomy

Women undergoing mastectomy to prevent or treat cancer have the option of having breast reconstruction surgery. This is a plastic surgery procedure that restores the shape and appearance of the breast.

Dr. Mitchell Brown, staff plastic surgeon at Women’s College Hospital, says that reconstruction isn’t something that all women who have breast surgery will wish to pursue, but they should be aware of the option.

“Many women who undergo treatment for breast cancer are comfortable with their decision to not undergo reconstruction, and never feel that reconstructing their breast is necessary for them,” Dr. Brown says.

For other women, breast reconstruction can improve quality of life. Breast reconstruction helps many women feel more comfortable with body proportions and balance. For others, it can help restore a sense of self, well-being and femininity.

“It’s critical to state that reconstructing a breast is certainly not necessary for a woman to feel feminine, but for many women it’s important,” Dr. Brown explains. “I think for some people it’s about trying to just get back to where they were before they had to undergo treatment for breast disease.”

One thing that is important for women to know when making decisions about breast reconstruction is that it is considered medically indicated surgery, and is covered by OHIP.

“In Ontario, and at the present time in all provinces across Canada, breast reconstruction is completely covered by health insurance,” Dr. Brown says. “I know from talking to many women that one barrier has been a perception that breast reconstruction was cosmetic and was something that they would have to pay for, and that kept some women from even considering it.”

Immediate and delayed reconstruction

Reconstruction can often be performed at the same time as the mastectomy, which is called immediate reconstruction. It can also be performed any time after the initial surgery – even years after. This is called delayed reconstruction.

For medical reasons, not all women are good candidates for immediate reconstruction.

“Women with more advanced disease may require surgical treatment, chemotherapy, radiation therapy and perhaps very close followup,” Dr. Brown says. “Those patients may not be ideal candidates to consider reconstruction, especially at the time of their mastectomy. It may be prudent for them to complete their cancer treatment, and then once they are determined to be doing well, could then undergo reconstruction at a later stage.”

Dr. Brown suggests two key factors for determining the timing of breast reconstruction surgery:

  • when the patient is ready and it’s the right choice for her, and
  • when she is healthy and doing well and has appropriately managed and treated her cancer, if she had cancer

Not all women who undergo mastectomy have a cancer diagnosis.

“We see so many women who are diagnosed with high-risk profiles who undergo preventive mastectomy,” Dr. Brown says. “The vast majority of these women undergo reconstruction. They are making an elective decision about removing their breasts, and most are quite motivated to consider options to reconstruct their breasts at the same time.”

Surgical approaches

There are two main approaches to breast reconstruction surgery: 

  • autologous reconstruction, which uses tissue from the patient’s own body to reconstruct the breast 
  • alloplastic reconstruction, which uses an implant to form the breast

“The most common way to do autologous reconstruction is to take tissue from the tummy,” Dr. Brown says. “It uses tissue that might be discarded if one were having a tummy tuck. And instead of discarding that tissue, we keep that tissue alive to reconstruct a breast, or two breasts.”

The advantage to autologous surgery is that it’s reconstruction with a patient’s own natural tissue.

“It can have a more natural feel when a woman touches her reconstructed breast,” Dr. Brown says. “If you’re doing one side only, it’s easier to match a natural opposite breast with natural tissue than it is with a breast implant.”

It’s also a one-time procedure: because there is no implant, there is nothing that will need to be changed or replaced in the future.

“However, the downside is that it tends to be a more involved, longer and more complex initial operation,” Dr. Brown says.  It also requires surgery in a second location on the body resulting in additional surgical scars and often the need to use a muscle for the successful transfer of the tissue.

Breast reconstruction using implants has the benefit of confining the surgery to the breast.

“It doesn’t involve moving tissue from anywhere else, or making an incision anywhere else on the body,” Dr. Brown explains. “However, it does involve the use of a medical device: the implant. As with any medical device, they’re not once-in-a-lifetime devices. They will likely have to be changed or adjusted at some point in a woman’s life, requiring further surgery.”

After the shape of the breast has been reconstructed using one of these two methods, a nipple is usually constructed in a separate procedure.

“In the majority of mastectomies today, the nipple is removed,” Dr. Brown says. “As a general rule, we reconstruct the breast mound and ensure that there is good symmetry and balance between the two sides. Once that’s been achieved, then we can select the site for the nipple – or nipples if it’s both sides – and then perform nipple reconstruction as a final stage.” 

Occasionally, a mastectomy can be performed without the need to remove the nipple (nipple sparing mastectomy) and in those cases, nipple reconstruction will not be necessary.

New trends in breast reconstruction include using fat from a woman’s own body to help enhance the results achieved during reconstruction.

“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,” Dr. Brown says. “That’s been a real evolution in what we’re able to do.”


This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Nov. 13, 2015.

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