NCCN Guidelines for Patients
Stages I and II Breast Cancer, Version 1.2014
Surgery/reconstruction Breast reconstruction
Methods to rebuild breasts
Some women choose to have breast reconstruction
after a lumpectomy or mastectomy. Breast
reconstruction means putting implants in or moving
tissues from other body parts to make a more
normal-looking breast mound. Other women use
external fake breasts or do nothing. The NCCN
recommendations for breast reconstruction are
presented next. Talk with your doctor about
these options. For more information on breast
reconstruction, visit the websites listed in Part 9.
If you will have a lumpectomy, your breast can be
re-shaped using volume displacement. Volume
displacement is the shifting of the remaining breast
tissue so as to fill the hole left by the lumpectomy.
Shifting of the breast tissue is often done right after
the lumpectomy by the cancer surgeon. If you choose
to have volume displacement, a larger piece of breast
tissue is removed but this likely reduces your chances
of cancer returning in that breast. Another benefit is
that the natural look of your breast is kept. If you don’t
like the results of the volume displacement, having
breast revision surgery may help. Breast revision
surgery is done by a plastic surgeon. You may have
another volume displacement, or you may want to get
implants or flaps, which are described below.
Sparing breast skin
If you will have a total mastectomy, your surgeon
may be able to save much of your breast skin. This
is called a skin-sparing mastectomy. Only the nipple,
areola, and skin near the biopsy site are removed.
Surgery that spares the nipple and areola should only
be done as part of a clinical trial.
There are benefits to having a skin-sparing
mastectomy. The size of the mastectomy scar will be
smaller, your breast will have a more natural shape,
and you will be able to have the reconstruction right
away if you want. To get the best results, your cancer
and plastic surgeons need to work well together.
Timing of reconstruction
You can have reconstruction at any time.
Reconstruction at the same time as the cancer
surgery is called immediate reconstruction. Delayed
reconstruction can occur months or years after the
Types of reconstruction
There are three ways to reconstruct breasts. All
involve having plastic surgery. Breast reconstruction
is generally safe, but with any surgery, there are risks.
Please ask your treatment team for a complete list of
the risks. The three ways to reconstruct breasts are:
Breasts can be reconstructed using breast implants.
Breast implants are small bags filled with salt water,
silicone gel, or both that are placed under the breast
skin and muscle. Implants have a small risk of
breaking and leaking. A balloon-like device, called
an expander, may first be placed under your skin
and inflated to stretch out your muscle and skin and
muscle. Every few weeks for two to three months, the
expander will be enlarged until the implant will fit in
place. You may feel pain from the expander stretching
your skin and muscle. In addition, some women will
have pain from the implant, scar tissue, or tissue
Another type of reconstruction uses tissue from your
body, known as “flaps.” Tissue is taken from the
belly area, butt, or from under the shoulder blade to
form breasts. Some flaps are completely removed
from your body then sewn in place. Other flaps stay