Women with a breast cancer diagnosis often choose a mastectomy because it reduces the risk of cancer returning by about 90%. Surgery to reconstruct the breasts can make them look the same as or even better than they did before, bringing back self-confidence lost in such a traumatic experience.
However, some patients put off reconstruction because they worry about cancer in reconstructed breasts returning. The truth is that there is always a chance of cancer coming back, but having surgery to rebuild the breasts does not increase the likelihood of it happening.
What Happens During Breast Reconstruction?
After surgery to remove the breasts, there are several options for breast reconstruction. Understanding these techniques can help to understand the chance of cancer recurrence.
- DIEP (deep inferior epigastric perforator artery) breast reconstruction. We take existing skin and fat from the lower abdomen and use it to rebuild the breast shape. Blood vessels from the abdominal tissue are matched to supplying vessels at the mastectomy site and micro surgically reattached.
- PAP Flap (profound artery perforator flap). When patients don’t have enough abdominal fat or DIEP is not possible, we use skin and fat from the upper thigh to rebuild the breast.
- Prosthetic breast reconstruction. After removing the breast tissue, we insert tissue expanders to form pockets where implants will lie. We then place saline or silicone implants into the pockets and cover them with existing skin.
- Transfer of tissue combined with implants. This option involves taking tissue from the abdomen or thigh to rebuild the breast and also inserting implants. Expanders are not usually required, making this option easier to tolerate than standard prosthetic breast reconstruction.
In any of the above, patients can opt to keep the nipple and areola intact, which means some of the original breast tissue remains.
What Are the Chances of Cancer in a Reconstructed Breast?
In general, there is a 2-3% chance of cancer recurrence after reconstruction. This is because, while most breast tissue is removed during a mastectomy, it’s impossible to remove all of it. Some cells remain along the chest wall in all surgery techniques; tissue remains under the nipple in nipple-sparing techniques; and tissue from donor sites on the body carry the patient’s breast cancer risk factors and DNA.
Patients who received a later stage diagnosis or who have certain genetic factors are at an increased chance of breast cancer returning. Again, these chances would be the same even before reconstruction for:
- Patients who were positive for the BRCA gene
- Patients who were diagnosed with stage 3 or stage 4 cancer
- Patients with larger tumors
- Patients with triple-negative cancers lacking ER, PR, and HER2
- Patients with inflammatory breast cancer
Will Implants Make It Harder to Detect Cancer After Breast Surgery?
Breast reconstruction does not make it difficult to find recurring cancer. Your surgical team is very aware of the need to check for new lumps in the breast and will show you how to feel the difference between implants and breast tissue. You will also schedule yearly exams to have your breasts checked by your medical team.
Not all patients who have mastectomies will need routine screening mammograms since there might not be enough breast tissue left to do a mammogram. If the oncologist believes there is a high risk of recurrence, he or she may recommend continuing screening.
When performed by a knowledgeable imaging specialist, research shows that mammograms will still detect cancer in patients with implants. The mammographer will take standard photos just as they would for someone without implants, then take additional shots after moving the implants out of the way. Patients who have had cancer in reconstructed breasts are advised to have a mammogram before getting implants and then within a year of implant placement to provide a comprehensive picture of their breast tissue.
After implant surgery, some patients put off mammograms fearing that flattening the breast will damage or “pop” the implant, but this is extremely rare. Radiologists are highly skilled at preserving implants. More importantly, the benefits of getting a mammogram far outweigh the risks of implant damage.
Breast Reconstruction Offers Enhanced Quality of Life After Cancer
The fear of cancer recurrence is completely normal, but there is no greater risk of recurring cancer in reconstructed breasts. After the emotional burden of losing the breasts, reconstruction allows women to move forward with a sense of normalcy. Our team of plastic surgeons truly cares about your well-being and will take time to address your concerns so you are confident that reconstruction is the right answer. Please contact The Breslow Center online today or call us at (201) 444-9522 to schedule a consultation.
