This post addresses three common questions my patients have following breast cancer reconstruction:

1. Will breast reconstruction hide other tumors that may later appear in the breast tissue?
2. Will breast reconstruction encourage the growth of new cancerous cells?
3. Should I continue with regular mammograms and breast self-exams?

Does breast reconstruction hide subsequent tumors?

During a mammogram, implants can occasionally interfere with obtaining a good picture, so your technologist must be trained at positioning the implant to enable the best possible image. In a flap reconstruction, the mammogram image may reveal surgical clips or scars, or the breasts might appear fatty, but an experienced technologist will be able to detect any abnormality. Breast reconstruction rarely, if ever, hides a return of breast cancer, so you shouldn’t consider this a significant risk when deciding to have breast reconstruction after mastectomy.

Will breast reconstruction encourage the growth of new cancerous cells?

No research has shown that reconstruction, either with implants or tissue flaps, increases the risk of the breast cancer returning or of a new cancer forming.

What about mammograms and breast self-exams?

After your reconstruction, whether it involves implants or tissue flap reconstructions, it is important to have regular mammograms at an experienced facility. I also encourage you to keep performing breast self-examination on both breasts as soon as you are fully healed from your surgery. This will enable you to notice and report any changes you feel. You should expect your reconstructed breast to feel different, and your doctor or nurse can help you understand the changes.

I’ve had over 20 years of experience performing breast reconstruction for patients from New York and all over the US, and I strongly believe that flap-type reconstructions offer my patients much better results than breast implant procedures would.

Implants vs. Flap Procedures: The Facts

To the body, breast implants are still a foreign substance, and they just can’t integrate with your body the way the fat and muscle used in flap procedures would. Complications of implants include:

• Capsular contracture - the body forms an unusually thick layer of scar tissue that squeezes and puts pressure on the implant
• Rupture of the implant shell
• Development of problems like the “bottoming out” and the “double bubble” deformities

Breast reconstruction surgery using implants can also pose extra challenges that some surgeons just aren’t used to dealing with. A mastectomy is bound to leave behind scar tissue, and in many cases will remove part of the pectoral that normally helps cover the implant and help it keep its position. Patients frequently come to my Long Island, New York practice to revise failed implant-type reconstruction, and in many cases part of the problem stemmed from the fact that their surgeons were not using techniques that take into account the special needs of reconstructive patients.

Flap-type breast reconstruction surgery, such as the DIEP flap procedure, avoids these problems because there is no implant, and the tissues used in the reconstruction are your own. Breasts reconstructed using this method look and feel like natural tissue because they are natural tissue.

… So, Why Aren’t All Breast Reconstructions Flap Procedures?

The basic answer is that these procedures are highly complex.

Flap surgeries require a high level of skill to perform correctly, and most surgeons’ training and experience leans much more heavily toward implant procedures. With flap surgery, the biggest challenges are to shape the breast in ways that balance well with the patient’s body, and to create a reliable blood supply to keep the reconstructed breast tissues healthy.

From a surgeon with genuine experience and authority in this area, this isn’t a problem – I’ve never had a patient go home from the hospital and experience flap failure. However, these aren’t surgeries that any “average” plastic surgeon can perform.

Helpful Resources:

• Questions to ask your New York breast reconstruction surgeon
• Details about breast reconstruction
• More information and case studies on implant-type breast reconstruction after mastectomy