Breast Reconstruction: Yes or No?

Patient Expert

One of the tougher decisions many women make around cancer treatment is whether to pursue breast reconstruction after surgery - either a major lumpectomy, or mastectomy. Here's some guidance on how to make that decision.

Q. I'm about to have a lumpectomy, but they're warning me I might ultimately need a mastectomy. Either way, I've been advised to look into reconstruction. That sounds pretty major, and I don't know if I want to do it"

A. Breast reconstruction, either after a lumpectomy or a mastectomy, can indeed be major surgery. There's a lot to consider as you make this decision:

-Can I take time off from work?

-Will insurance pay for it?

-What are the physical risks?

-Can it fail?

-What will my new breast look like, and feel like?

Lots of questions. In my opinion, the most important thing to consider is this: How will I feel about the way I look if I don't have reconstruction, vs. if I do?

Reconstruction is somewhat about physical balance, but mostly about looks - though if you have any guilty thoughts about making this decision purely for "vanity's sake," get rid of them right now.

Reconstruction (or no reconstruction) is really about feeling normal and healthy, even though you've lost your breast (or part of it). It's about taking your life back and feeling good about yourself, both emotionally and physically. It's about looking in the mirror, and being comfortable with what you see - whether that's a reconstructed breast, or a flat plane where your breast used to be.

Many women have a bilateral mastectomy with no reconstruction, don't wear a prosthesis (a pad that slips into your bra to look like a breast), and are happy with how they look. I know one woman who, instead of reconstruction, had a beautiful, intricate tattoo done; now, flowers and vines encircle her trunk, where her breast used to be. She loves it.

AND THAT'S THE POINT. Whatever you do (or don't), this is about how YOU feel, no one else. If you don't want reconstruction, fine. If you do, go for it. But don't let anyone's advice or comments make you feel guilty, one way or another. What could be more personal than your own body geography?

Q. You say it's all about me. But what about my significant other? S/he should have some say too, right?

A. Sure, if that's the kind of relationship you have, one where you make decisions together. But there's no "should" about this; every couple lives by their own rules.

One way or another, you'll talk about this; and s/he may be very hesitant to give advice, for fear of saying the wrong thing, or "forcing" you in a direction you don't want to go. Or, s/he may have very strong opinions, and let you know what they are. Only you know how to navigate this potential minefield: your desires, vs. your mate's.

I'm no psychologist, but one thing I'd caution against is this: getting reconstruction because you feel you'll be "unlovable" or unattractive, in your other's eyes, unless you do. Love based on appearance is on shaky ground" and a decision this major should have some pretty firm ground beneath it.

Bottom line: From choosing not to undergo reconstruction (and wearing or not wearing a prosthesis), to implants, to reconstruction using your own tissue, you have a variety of options after a major-excision lumpectomy or mastectomy. Examine them all fully - with your doctors, your family, your friends, if you like - then follow your heart. Make this decision for yourself, no one else; because you're the one who'll live with it, potentially for the rest of your life.

One final note: If you're considering reconstruction and haven't yet spoken to your oncologist or surgeon about it, understand that you simply might not be a good candidate. The nature of some women's cancer, their treatment schedule, previous surgeries, or underlying health conditions can all rule out reconstruction.

Read more:

Breast Reconstruction: Choosing What Type

Breast Reconstruction: Body Tissue (Autologous) Reconstruction

Breast Reconstruction: Implants

Choosing a Prosthesis or Breast Form