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What Are My Options For a Mastectomy?

Advancements in breast removal and reconstructive surgery provide new options for women with breast cancer.

There is no one-size-fits-all treatment option for breast cancer. Instead, the option that is best for you is dependent on the location, size, stage and type of breast cancer you have, as well as your body’s health and sensitivity to hormones and your personal preferences.

In most cases, your doctor will suggest a mastectomy. A total mastectomy removes all breast tissue, including the fatty tissue, skin, nipple and areola. A skin-sparing mastectomy removes the breast tissue but leaves the skin over the breast intact so that it can be used after surgery.

After a mastectomy, which removes all of your breast tissue, reconstruction can occur at different times.

  • Immediate reconstruction occurs in the same surgery as breast removal, if given the go-ahead by your oncologist. The removal and plastic surgery will be coordinated so that you wake up with a rebuilt breast or breasts. When a mastectomy is performed to reduce a high risk of breast cancer, reconstruction almost always is done at the same time.
  • Delayed reconstruction is scheduled when radiation and chemotherapy treatments are complete, sometimes up to 12 months after. One reason is that radiation therapy is known to cause changes to an implant, such as scarring or hardening. Delayed reconstruction also is suggested by some doctors to give patients more time to recover emotionally from the surgery and consider their options.

Once you and your doctor have decided when to perform reconstructive surgery, you can choose the type of surgery that is best for you. There are two types:

  • Implant reconstruction, which uses an artificial implant to rebuild the breast. The procedure is similar to breast augmentation, with a saline or silicone gel implant inserted underneath the chest muscle. In most cases, implant reconstructive surgery is easier and has a shorter recovery time. The downside is that implants must be replaced, so future surgeries are required.
  • Autologous reconstruction, also called tissue flap procedures, which transplants tissue from another part of your body to create a breast shape. There are many types of tissue flaps, such as TUG, PAP, TRAM, DIEP and SIEA, named for the area of the body where the tissue is removed. A common way for this procedure to take place is for a woman to have a tummy tuck and then use the belly tissue that is cut away for breast reconstruction.
  • Tissue flap reconstruction has a natural feel, and because the new tissue is attached to blood vessels in the chest, it acts like normal tissue, even shrinking or enlarging as you gain weight. It is also permanent; there is no need for additional surgeries. But tissue flap reconstruction also requires that surgery be performed on other areas of the body, which increases the patient’s recovery time.

Wary of plastic surgery? So are 44 percent of women who have a mastectomy, who also choose not to have reconstructive surgery.

Some of these women want to return to their active lifestyle as soon as possible. Others are concerned about the health risks, or the cost of surgery if they don’t have insurance. Whatever your concerns may be, you should bring them up with your doctor so that together, you can make the best decision for your unique situation.

“Ideally, a comprehensive breast care center like the one at USC Norris Comprehensive Cancer Center can provide a team approach from diagnosis to healing,” said Alex K. Wong, MD, an associate professor of surgery at the Keck School of Medicine of USC who specializes in breast reconstruction and aesthetic surgery. “If your radiologist, oncologist, radiation oncologist, surgical oncologist, and plastic surgeon all know each other and are familiar with your case, they can make a unified, informed decision about moving forward.”

By Heidi Tyline King

As one of the eight original National Cancer Institute (NCI)-designated comprehensive cancer centers in the United States, USC Norris Comprehensive Cancer Center at Keck Medicine of USC is one of the preeminent academic medical institutions in the country. If you are in the Los Angeles area, make an appointment by calling (800) USC-CARE (800-872-2273) or visiting