Questions about mastectomy

Can I have breast reconstruction at the same time as my mastectomy?

Most women can undergo at least part of a breast reconstruction procedure at the same time as their mastectomy. Breast reconstruction can be done later as well. For some kinds of reconstruction, more than one surgery is needed. Women should have a full consultation with a plastic surgeon before deciding between mastectomy and breast-sparing surgery. The plastic surgeon can explain the different breast reconstruction methods, including possible complications. This information can help a woman make a choice about surgical treatment.

Can I have a mastectomy without removing the nipple? What about the breast skin?

Most surgeons recommend removal of the nipple because cancer cells can grow there. Nevertheless, with some types of cancer that are not located near the nipple, it is possible to undergo a type of mastectomy in which the nipple is saved. However, this nipple-sparing surgery is rarely done. A nipple-sparing mastectomy is more likely than a total mastectomy to leave breast cells behind that could later become cancer. Moreover, because the nerves are cut, neither the nipple nor the breast will have the same sensations after any type of mastectomy that they had before the surgery.
When breast reconstruction is done at the same time as the mastectomy, the surgeon often is able to save most of the breast skin to use in the reconstruction.

With reconstruction, can I change the size of my breasts? Can the plastic surgeon make the other breast match? Can the plastic surgeon make the breast look natural? Will I have any feeling in the reconstructed breast?

In many cases, a plastic surgeon can change the size of the breasts. Sometimes, surgery on the healthy breast also is needed so it will match the reconstructed breast. Reconstruction using a woman's own tissue often looks more natural than with implants, which tend to be higher and rounder than a natural breast. With tissue flap surgery, the breast is reconstructed using muscle, fat, and skin from other parts of the body, such as the abdomen or back. Tissue flap surgery is more complex than reconstruction with implants. Women who have had a mastectomy with reconstruction — either with implants or her own tissue — will not have much (or perhaps any) sensation in their breasts, because the nerves to the breast skin have been cut. And, although nipples can be reconstructed, they will not have any sensation.