Visually any women who must lose her breast to cancer can have it rebuilt through reconstructive surgery. But there are risks associated with any surgery and specific complications associated with this procedure.

In general , the usual problems of surgery, such as bleeding, fluid collection, excessive scar tissue, or difficulties with anesthesia, can occur although they’re relative uncommon. And, as with any surgery, smokers should be advised that nicotine can delay healing, resulting in conspicuous scars and prolonged recovery. Occasionally, these complications are severe enough to require a second operation.

If an implant is used, there is a remote possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection cleats. A new implant can later be inserted.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

Reconstruction has no known effect on the recurrence of disease in the breast nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur. Your surgeon may recommend continuation of periodic mammograms on both the reconstructed and the remaining normal breast. If your reconstruction involves an implant, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast reconstructed with an implant.

Women who postpone reconstruction may go through a period of emotional readjustment. Just as it may feel anxious and confused as she begins to think of the reconstructed breast as her own.

You can begin talking about reconstruction as soon as you’re diagnosed with cancer, ideally, you’ll want your breast surgeon and your plastic surgeon to work together to develop a strategy that will put you in the best possible condition for reconstruction.

After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for you age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your options and the risks and limitations of each. Post-mastectomy reconstruction can improve your appearance and renew your self-confidence - but keep in mind that the desired result is improvement, not perfection.

Your surgeon should also explain the anesthesia he or she will use, the facility where surgery will be performed, and the costs. In most cases, health insurance polices will cover most or all of the cost of post-mastectomy reconstruction. Cheek your policy to make sure you’re covered and to see if there are any limitations on what types of reconstruction are covered.

Your oncologist and your plastic surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking and taking or avoiding certain vitamins and medications. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

If your surgeon recommends the use of an implant, you’ll want to discuss what type of implant should be used. A breast implant is a silicone shell filled with either silicone gel or a salt-eater solution known as saline.

Because of concerns that there is insufficient information demonstrating the safety of silicone gel-filled breast implant, the Food & Drug Administration has determined that new gel-filled implants should be available only to women participating in approved studies. This currently includes women who already have tissue expanders ( see below under skin expansion), who choose immediate reconstruction after mastectomy, or who already have a gel-filled implant and need it replaced for medical reasons. Eventually all patients with appropriate medical indications may have similar access to silicone gel-filled implants.

The alternative saline-filled implant, a silicone shell filled with salt water, continues to be available on an unrestricted basis, pending further FDA review.

As more information becomes available, these FDA guidelines may change. Be sure to discuss current options with your surgeon. (Above guidelines are current as of July 1992).


While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that’s best for you.

Skin expansion. The most common technique combines skin expansion and the subsequent insertion of an implant.

Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or moths. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure. (For more information on tissue expansion, ask your surgeon for the ASPRS brochure on this procedure.)

Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.