Commonly asked questions about breast reconstruction answered

Imagine that a part of you was taken away, and you were left with a constant physical reminder that it was gone.

Breast cancer affects roughly 27,700 Canadian women each year. Many of these women undergo a single or double mastectomy to treat their cancer. Breast reconstruction is offered to patients once the breast is removed.

Dr. Josh Vorstenbosch and Dr. Peter Davison, two plastic surgeons at the McGill University Health Centre (MUHC), answer the most commonly asked questions about breast reconstruction.

What are the different types of breast reconstruction?

“We can do breast reconstruction one of two ways. We can use your own tissue, implants, or a combination of both,” says Dr. Vorstenbosch. “With the tissue-based method, there needs to be sufficient tissue available. Benefits of this method include a more natural, longer-lasting breast reconstruction and a tummy tuck when the tissue is removed.”

“In contrast, implant-based breast reconstruction is used when there is not enough tissue or when the patient desires a shorter recovery time,” says Dr. Vorstenbosch. “A slim woman with moderate-sized breasts may not have enough abdominal tissue to reconstruct the breast to her desired volume.”

Can patients choose the type of implants they receive?

“Within the context of their body, shape and size, yes,” says Dr. Davison. “There is a limit on size based on what is doable, but the end decision is patient-driven.”

What are the challenges with reconstructing only one breast?

“It’s impossible to make an implant look like a natural breast. You just cannot do it,” says Dr. Vorstenbosch. “Instead, patients may opt for a breast lift on the non-cancerous breast to make the breasts more similar.”

“What’s wonderful in patients who had a unilateral mastectomy is when we make the breast out of their own tissue,” says Dr. Vorstenbosch. “It’s much easier to make living tissue look like living tissue.”

How does nipple reconstruction work?

“Reconstructed nipples are made through a series of cuts and folds in the skin, like surgical origami,” says Dr. Vorstenbosch. “However, reconstructed nipples do not have any sensation.”

“In addition to nipple reconstruction, a patient can get a tattoo to add pigmentation,” says Dr. Vorstenbosch. “Tattoo artists can perform phenomenal three-dimensional tattoos that look like natural nipples from a distance.”

Does breast reconstruction leave scars?

“The best scars are hidden, for example around the areolas or underneath the breast,” says Dr. Davison. “The visible scars across the breast do fade slightly after a year or two, but how much they fade is dependent on skin type.”

Who is eligible for breast reconstruction?

“Breast reconstruction is possible for most patients. The exception would be if the patient was medically unfit to have the surgery, or if they have metastatic cancer,” says Dr. Vorstenbosch.

Is breast reconstruction covered by RAMQ?

“Yes, almost all aspects of breast reconstruction are covered by RAMQ. This also includes revision surgeries for the purpose of improving symmetry and patient preference,” says Dr. Vorstenbosch. “The only thing not covered is the nipple tattoo.”

Can breast cancer come back in a reconstructed breast?

“Although breast cancer can come back in the reconstructed breast, it is exceedingly rare. The risk of recurrence following a mastectomy and reconstruction is no different than following a mastectomy alone,” says Dr. Vorstenbosch. “The patient’s surgical oncologist will schedule regular follow ups and explain how to screen for additional cancers.”

Are there alternatives to breast reconstruction?

“Some women choose not to have breast reconstruction at all. It is a very personal choice. Padded bras or breast prostheses can help to balance out their chest and clothes,” says Dr. Vorstenbosch.

How long do patients have to wait before breast reconstruction?

“The timing of breast reconstruction depends on many factors. We often work with the surgical oncologist to perform some form of immediate reconstruction at the time of mastectomy. Most reconstructions occur over multiple stages, and factors that impact the timing of final reconstruction include whether the patient needs chemo or radiation therapy and operating room availability,” says Dr. Vorstenbosch.