NCCN Guidelines for Patients
Breast Cancer - Carcinoma in Situ
, Version 1.2016
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
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
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).
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.