Which type of breast reconstruction is right for you

The aim of breast reconstruction is to recreate the shape of the breast. This is different from 'flat closure', where the aim is to create a neat, smooth scar without creating a breast mound.

This can be a difficult and complex decision, but information and support are available to help you. Ultimately, the choice is yours. You should not feel pressure to make a decision you are not comfortable with. 

Depending on your decision, you may need to see additional specialists such as a plastic surgeon.

You should ask your treating team how much time you can take to make your decision.

The differences to consider

We explain some of the main differences between:

• reconstruction using breast implants
• reconstruction using your own tissue - tissue-based reconstruction or 'autologous' reconstruction such as 'flap' surgery
• flat closure - also called aesthetic closure or staying flat.

Thinking about how important these factors are may help your decision.

The way the breast or chest looks

The results of surgery are improving all the time but will vary from person to person and surgeon to surgeon. For some people, it is important how their chest or breast looks with and without clothes. This can affect their decision.

Reconstruction using breast implant(s)

After a single mastectomy, the new breast may look different from the breast you had removed and different from your existing breast.

With double mastectomy and both breasts reconstructed, they will look very similar to each other.

Sometimes the skin of the breast – especially in people who are slim – may ripple, or wrinkle.

You may have a slightly unequal appearance if the breast implant moves slightly. This can also happen if you need radiation therapy, which sometimes causes the implant to shrink a little.

Breast implants come in many different types and shapes. Your surgeon will talk to you about which will suit you the best.

The way the breast or chest feels

The ‘feeling’ can relate to what it’s like for you to touch the skin or reconstructed breast, or how someone else experiences it through a hug.

The ‘sensation’ may also be different: this can range from numbness (no sensation), tingling, pins and needles to feeling fully or mostly like the skin or existing breast. 

Reconstruction using breast implant(s)

If you had a single mastectomy and an implant reconstruction, your breasts will feel different from each other.

An implant may feel less natural because it may be firmer, heavier and colder to touch.

Sometimes a ‘capsule’ can develop around the implant, and it can feel firmer than your remaining breast.

You will probably have less sensation in the nipple (if you keep it) and skin of the reconstructed breast. For many people this may be permanent.

Reconstruction using your own tissue

In the short term after surgery, you will have no feeling at all in the reconstructed breast. For most people, sensation never comes back. For people who do regain feeling, it takes from 6 months to 2 years, as the nerves need to regrow.

You may also feel numbness or less sensation where the tissue was moved from, such as your lower belly, upper thigh or back.

Scars: how many and where they are

Many people find their scars fade over time. We have tips to help reduce scarring.

Reconstruction using breast implant(s)

The cut for implant surgery is usually in the same place as the mastectomy scar, so overall scarring is less.

Reconstruction using your own tissue flap

When you use your own tissue, you will have scars in the breast and in the area the tissue is taken from. Usually this is the tummy, back, buttocks or inner thigh, so you are recovering from 2 surgical sites. Find out how to manage scars.

The surgeries you might need

You may need several procedures to achieve the result you want. The additional surgery or surgeries can be months or years after the reconstruction. In the public health system, wait times and costs can vary as delayed reconstruction is classed as elective surgery. This can affect your decision.

Reconstruction using breast implant(s)

Reconstruction may happen at the same time as your mastectomy. This is ‘immediate reconstruction’ and is a single surgery.

‘Delayed reconstruction’ is a second surgery, weeks, months or even years after the mastectomy.

You may also need surgery to replace the implant, although they often last more than 10 years.

Over time, you may need several procedures, including surgery on your non-affected breast to make your breasts more symmetrical. Read About surgery to improve breast symmetry.

Reconstruction using your own tissue flap

You may need several procedures, including surgery on your non-affected breast to make your breasts more symmetrical.

How your breasts will change over time

Reconstruction using breast implant(s)

A natural breast changes over time and will droop as you get older. Reconstructed breasts, especially using implants, will not change in the same way.

If you lose weight or gain weight, your implant will not change size.

Over time, differences between a natural and reconstructed breast may become more obvious. You may want further surgery to improve breast symmetry to make them appear more similar.

Other factors to consider

When you’re trying to decide on the best option for you, other things to think about include:

• the possible impact on treatment, such as delays in starting chemotherapy or radiotherapy due to surgical complications
• travel time for surgeries and appointments if you live in a regional, rural or remote area
• waiting times for elective (non-emergency) surgery in public hospitals
• the cost of surgery (implant-based reconstructions are often simpler so they cost less)
• whether a public hospital offers the type of surgery you want
• the impact on your family life
• your job – your working environment and taking leave from work
• the support you may need, from practical, emotional and financial support to childcare
• hobbies or daily activities such as driving or playing sport or a musical instrument
• wanting to be ‘done with it’ after the initial mastectomy
• fear about things going wrong or the cancer coming back.

Help to make the decision

It is common to feel anxious and unsure about this important decision. Help and support is available and you can contact our Helpline on 1800 500 258.

These tips are from our members who have been through breast reconstruction or flat closure and from health professionals.

1. Read about, watch or listen to the options

Your surgeon may give you information, or you can read:

• About breast implant surgery
• About breast reconstruction using your own tissue
• About staying flat after mastectomy

We have several videos and podcasts about the options and what to think about when making a decision:

• Breast reconstruction – know your options (2019).
  Breast cancer specialists and a consumer who chose to ‘stay flat’ discuss options and issues for people to consider.
• Breast reconstruction (podcast ‘Upfront about breast cancer’, episode 7). Host Kellie Curtain speaks to plastic and reconstructive surgeon Richard Zinn and breast cancer survivor Kellie Shewring about reconstruction – including whether to have one at all.
• Breast Reconstruction – Options and Expectations. Presentations from a 2021 BCNA conference cover the options, expectations, and the emotional and physical impacts of breast reconstruction.

External resources are also available:

• Cancer Council booklet Understanding breast prostheses and reconstruction – a guide to options after breast surgery
• Cancer Australia’s Breast reconstruction and flat closure information.

2. Ask your healthcare team

Ask as many questions as you need to understand the options available. Do not feel afraid to ask for a second opinion.

Ask your breast surgeon

Your breast surgeon should discuss all options, even if they are not available at your hospital. Ask them which other hospitals do provide the options you want. This will allow you to decide which is the right type of reconstructive surgery.

We have some suggested questions to ask your surgeon about breast reconstruction.

Ask your breast care nurse, whose role is to support and provide care for people with breast cancer.

Ask for a referral to a plastic surgeon who:

• specialises in breast reconstructive surgery
• has skills in microsurgery.

3. Look at images to see which option you prefer

Ask your surgeon or breast care nurse for photos of the different options.

Talk to other people who have chosen to stay flat or had the type of reconstruction you are considering. Ask them if they are willing to share photos.

In the private Online Network groups Choosing breast reconstruction and Flat Chat – no breast reconstruction, members share their experiences, including photos.

4. Talk to people who have had these surgeries

Find out what has helped other people make their decision. 

Connect with people in our Online Network through:

• private groups – Choosing breast reconstruction and Flat chat – no reconstruction.
• public discussions about treatment and surgery

5. Talk to a psychologist 

You may find it helpful to talk to a psychologist about your decision. A psychologist who has experience in helping people through cancer treatment is called a ‘psycho-oncologist’.

They can help you understand:

• what is most important to you
• what is influencing your decision.

Talking through your concerns can give you confidence to make a decision, especially if you don’t have much time.

Find out how to access psychology and counselling services. If you aren’t sure about the psychologist’s experience, let them know you are affected by breast cancer and ask if they can give you support around surgery decision-making.

You can also ask your treating team to put you in touch with a social worker if you need help with your family or finances.

If you change your mind about breast reconstruction

Sometimes it is OK to change your mind or put off making the decision. 

You may make a choice that is right at the time but change your mind afterwards. This can happen soon after surgery or years later.

In most cases, it is not too late to change your mind.

If you have a breast reconstruction with an implant, you can have surgery to ‘go flat’ later.

Or, if you stayed flat after your mastectomy, but decide life without a reconstruction is not for you, you can talk to a surgeon about options.

The wait times for a consultation can vary widely around Australia. If the wait time is long, you can ask your GP or original surgeon for a referral to someone else.