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32

NCCN Guidelines for Patients

®

Breast Cancer - Carcinoma in Situ

(stage 0)

, Version 1.2016

3

DCIS

Breast reconstruction

Breast reconstruction

Some women choose to have breast reconstruction

after a lumpectomy or mastectomy. Breast

reconstruction is a surgery that inserts breast

implants or uses your body tissue to make a more

normal-looking breast mound. Other women use

external fake breasts or do nothing. Options for breast

reconstruction are described next. Talk with your

doctor about these options.

Reconstruction following lumpectomy

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 by the

cancer surgeon right after the lumpectomy.

A larger piece of breast tissue is removed during

lumpectomy for volume displacement. Despite a

larger piece, the natural look of your breast will be

kept. Besides, having a larger piece removed will

likely reduce your chances of cancer returning in that

breast.

You may not like the results of the volume

displacement. In this case, breast revision surgery

may help. Breast revision surgery is done by a plastic

surgeon. Other options include a second volume

displacement, or you may want to get breast implants

or flaps, which are described below.

Reconstruction following mastectomy

You can have reconstruction at any time if you have a

total mastectomy. Reconstruction at the same time as

the cancer surgery is called immediate reconstruction.

Delayed reconstruction can occur months or years

after the cancer surgery. Breast reconstruction

following a mastectomy is done by a plastic surgeon.

To enhance your breast reconstruction, you may

be able to have a skin-sparing mastectomy. This

surgery usually removes only the nipple, areola, and

skin near the biopsy site. As a result, the size of the

mastectomy scar will be smaller and your breast will

have a more natural shape. Skin-sparing mastectomy

that spares the nipple and areola may be an option

for some women.

There is more than one way to reconstruct breasts

and nipples after a mastectomy. All reconstruction is

generally safe, but with any surgery, there are risks.

Ask your treatment team for a complete list of side

effects. The ways to reconstruct breasts and nipples

are:

Implants

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 or

muscle and inflated to stretch out the tissue. 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. Some women will also have pain from the

implant, scar tissue, or tissue death (necrosis).

Flaps

Another type of breast reconstruction uses tissue

from your body, known as “flaps.” Flaps are from the

belly area, butt, or from under the shoulder blade.

See Figure 3.4

. Some flaps are completely removed

from your body and then sewn in place. Other flaps

stay attached and then are slid over to the breast

area and are sewn into place. Women who have

diabetes or who smoke are more likely to have

problems with flaps than other women. Some risks of

flaps are tissue death, lumps from death of fat, and

muscle weakness that may cause a hernia.