Breast Reconstruction After Lumpectomy | I'm Taking Charge

Breast Reconstruction After Lumpectomy

Breast Reconstruction After Lumpectomy

There are many different breast reconstruction procedures available after lumpectomy, with or without radiation. One of the most common is to take fat from another part of the body and fill it in the breast. This is called lipofilling. Sometimes breast lifts or reductions to the opposite breast may bring symmetry. It’s important to understand, first and foremost, that getting a lumpectomy (and radiation) doesn’t mean you can’t have breast reconstruction.

What’s a Lumpectomy?

A lumpectomy involves the removal of just the tumor found in the breast and some of the non-cancerous tissue surrounding it–not the entire breast as with a mastectomy. This surgical procedure conserves the breast, which is good. Unfortunately, it may leave the breast with a dent, bulge, or imperfection near the surgical site. After a lumpectomy, the breast or breasts are likely to be different in size. Sometimes the breasts may seem asymmetrical. Because of this, many women choose breast reconstruction after a lumpectomy.

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The Susan G. Komen website assures readers that breast cancer patients who have lumpectomies (along with breast radiation) face the same survival odds as those who have mastectomies. It also reports that oncologists have been encouraging women with early-stage breast cancer to choose a less radical surgery than mastectomy.

A U.S. News & World Report article from 2015 cites an expert panel assembled by the National Cancer Institute in 1990. The panel stated that “lumpectomy with radiation was ‘preferable’ to mastectomy for women with stage 1 or 2 breast cancer.” This information contributed to a reduction in mastectomy rates for those patients. It dropped from 100 percent in the 1980s to less than 40 percent in 2015. Lumpectomies now account for somewhere between 60-70 percent of cancer surgeries.

Plastic surgeons recommend waiting six months to a year after a lumpectomy before having breast reconstruction. That time will allow the breast tissues to heal. It also allows any distortion or asymmetry to stabilize. Studies have shown that after a lumpectomy about 46 percent of women were unhappy with the physical appearance of their breasts.

Patricia Velasquez had breast reconstruction after a lumpectomy. Take a look at her story in this video.

Immediate Lumpectomy Reconstruction

Immediate reconstruction with a lumpectomy means that the breast reconstruction occurs at the time of the lumpectomy. This is actually the least common scenario. Most women wait until after the lumpectomy to see if they feel it needs work. However, if a woman and her surgical team choose immediate reconstruction, the results may be the most aesthetically pleasing.

One example of immediate lumpectomy reconstruction is oncoplastic surgery. Oncoplastic surgery combines the latest plastic surgery techniques with breast surgical oncology at the time of the lumpectomy. An oncoplastic surgeon rearranges some of the remaining tissue in order to realign the nipple and areola. This procedure should restore a natural appearance to the breast shape. The surgeon may recommend a lift or reduction to the opposing breast to restore symmetry.

breast reconstruction after lumpectomy

Another option is the bilateral breast reduction or lift. The surgeon will remove breast tissue from the cancerous breast and modify the normal breast to create symmetry.

Unfortunately, there is a possibility of not being able to preserve blood supply to the nipple during surgery using this method, necessitating a free nipple graft. A free nipple graft removes the nipple and replaces it after the breast reduction or lift is complete. However, the free nipple graft can result in nipple numbness and inability to breast-feed, making it a “last resort” procedure.

 

Breast Reconstruction After Lumpectomy and Radiation

If radiation therapy follows a lumpectomy, the type of reconstruction may be impacted. Radiation damages the skin and tissue around the breast. The method of reconstruction will then depend on the condition of the skin.

Radiation can cause shrinkage of the breast and contribute to breast asymmetry. While radiation does not affect all women the same way, for some women the breast, particularly around scar tissue, hardens. The breast feels much tighter, and the skin and tissue underneath are less stretchy. To reconstruct a breast in this situation, a plastic surgeon may remove the hardened tissue and fill the breast with tissue or fat taken from other areas of the body.

  • Using a Tissue Flap: When transplanting healthy, non-irradiated tissue to the breast, the flap behaves more like normal tissue. The non-irradiated tissue may even bring health back to some of the radiation-impacted tissue. The surgeon can take a donor flap from the abdomen, the back, the rear, or even the thigh. It is possible for reconstruction to be made totally of transplanted flap tissues. If there is not enough tissue available, the flap can be used with tissue expanders and implants.
  • Lipofilling: Lipo means fat, and filling is what it sounds like. Essentially, lipofilling uses fat from other areas of the body to fill the breast.  

Again, because each surgical situation is different, there is no typical approach to reconstruction after a lumpectomy or with or without radiation. The surgeon will personalize the surgery based on previous treatments, goals and expected outcome.

If you’re having radiation, you may want to read more about breast reconstruction options after radiation.

 

 

2018-05-07T01:24:20+00:00


21 Comments

  1. Avatar
    Dave Anderson June 13, 2017 at 3:54 pm - Reply

    My mother in law recently had to undergo several procedures due to breast cancer but in the end, she recovered fully. Like you mentioned, radiation causes a lot of different changes in the breast tissue so I think that it would be important for people like my mother in law to be able to get procedures to normalize her breasts. That way she will still be able to feel beautiful after the procedures.

    • Sally Casey
      Sally Casey August 24, 2017 at 9:05 pm - Reply

      Sorry to hear about your mother-in-law’s breast cancer, but I’m so glad she is better now!

  2. Avatar
    Jacqueline Bunting August 23, 2017 at 1:47 pm - Reply

    You can still be beautiful without breasts. Reconstructed breasts aren’t real, there is little or no feeling & in fact depending on what type of reconstuction they can feel hard & artificial. Why you would want to put yourself through more surgery is beyond me. Yes, I am a breast cancer survivor.

    • Sally Casey
      Sally Casey August 24, 2017 at 9:08 pm - Reply

      This is so true, Jacqueline! I think you’ll like one of our guests next month. She will be sharing why she chose not to reconstruct. I’ll link back here to her podcast interview and article once they’re up!

    • Sally Casey
      Sally Casey September 13, 2017 at 6:48 pm - Reply

      Hello again, Jacqueline! Here’s the article: https://imtakingcharge.com/reflections-going-flat-whole-without-breasts/. It’s beautifully written, too. Enjoy!!

    • Avatar
      Pk February 19, 2018 at 1:10 am - Reply

      That is a very judgmental comment. Everyone is different and feels different about their body. My breasts are my womanhood and you bet I am willing to go through another surgery to feel whole again.

    • Avatar
      Angel April 20, 2018 at 2:54 am - Reply

      My reconstruction is scheduled for May 4th, after 13 years. I was diagnosed at 36 am now 49. They are going to still be real!! I had lumpectomy 3x over the years, and radiation all those years ago has caused me to be 2+cup sizes different one the radiated side. Which causes for much pain in neck and back. Prosthesis is so heavy! So WHY would I choose reconstruction? For very good reasons. All Reconstructions aren’t the same, so you are very wrong in saying ” they aren’t real”.! I haven’t had a mastectomy so what I have left is still mine so a reduction and a lift doesn’t invited implants. So how again are my breasts not real? Might want to re think how you word things. Every woman makes her own choices. There is no right or wrong, and shame for judging other survivors for their choices that were not the same as yours!

      • Kara Skarda
        Kara Skarda April 21, 2018 at 1:04 am - Reply

        I just want to give you a big high five, Angel! Don’t worry about the naysayers. I hope your reconstructive surgery goes well and that your back and neck pain improve with the surgery.

  3. Avatar
    Adrienne January 30, 2018 at 7:28 pm - Reply

    I agree with Jacqueline! While it is everyone’s individual choice, of course, the women who have chosen to remain “flat” after their mastectomy look beautiful to me.

  4. Avatar
    Lauren March 14, 2018 at 1:11 am - Reply

    Hi all,
    I had a lumpectomy in early January and just finished 4 weeks of radiation. I’m wondering what to expect cosmetically… right now my radiated breast is swollen (and of course red) and seems to be about 1/2 cup size or so bigger than my non-radiated breast. My surgeon said that I should wait several months, but that down the road there is the option of cosmetic surgery if I am unhappy with the appearance of my breasts. Does anyone have insight into what the expect after radiation as far as the appearance of the breast?

    • Avatar
      Dee December 22, 2018 at 8:46 am - Reply

      Hi Lauren,

      I’m in the same situation as you. I had a lumpectomy in November 2017 and finished 4 weeks of radiation in January 2018. A year later and my radiated breast is still noticeably larger than the untouched side. This is opposite of what most women experience. I have consulted with surgeons, weighing my reconstruction options. One of the doctors said the radiation may have had the effect of a breast lift… tightening/firming and lifting the one side and making it appear larger. Not to mention scar tissue. After nursing two children, my original boobs weren’t in the best shape. Now the radiated side appears more plump. I’m trying to decide whether to remain lopsided, do fat grafting or implants. Call it vanity, but to me personally, cancer stole so much from me. I’d like to feel “whole” again at least physically.

  5. Avatar
    Mary April 29, 2018 at 8:47 pm - Reply

    It took my radiated breast after a lumpectomy at least a year to stop changing. It got smaller and smaller and smaller. I’m sure everyone is different but I definitely would wait a while before doing surgery.

  6. Avatar
    Tommie July 6, 2018 at 1:42 pm - Reply

    I had a lumpectomy last May. Did 6 weeks of radiation which I completed in Dec. 2018. The
    radiated breast ended up about a cup size smaller. I waa very large breasted to begin with. I opted to have a lift and reduction which was done a week ago. The nipple after radiation was a little tougher and darker. But after surgery it was Real dark. My surgeon said it is because of a compromise in blood flow. There may be a chance i will loose the. Nipple. Its a wait and see for now. I have no regrets though even if I do loose it. The other one is great with complete sensitivity.

  7. Avatar
    Ginger August 28, 2018 at 7:32 pm - Reply

    I’m 64 years old. In 1994 I had a lumpectomy and radiation on my right breast. Over the years my left breast has continued to age, sagging and all that good stuff. My right breast is now at least 2 sizes smaller than my left. It’s like it has been frozen in time. Stuffing my bra for over 20 years will soon be ending. After seeing 3 plastic surgeons over the years, I have finally decided to do something. I’m having surgery later this month to get an implant and fat grafting done to my right breast. I will also have a lift done to my left breast. Yes, at 64 years old I’m doing it and I can’t wait to burn my breast forms!

    • Avatar
      Twee September 27, 2018 at 5:24 pm - Reply

      Ginger,

      I am 58 yrs old now. At age 30 I had a lumpectomy and radiation on my left breast. For 28 yrs long with stuffing bra. I finally go see 1 plastic surgeons and plan to have implant with my own fat tissue. After few viewing online about flap procedures I feel scare and i feel very painful already. Ginger, I hope every went well with you.

    • Avatar
      Karen February 28, 2019 at 12:37 pm - Reply

      Ginger,
      I am 65 years old and had 3 lumpectomies in 1996 on my right breast. I too am tired of stuffing my bra. I was wondering if you did have the procedure done, and if you would recommend others at our age to do this. When I look at my breasts it is always a reminder of a very difficult time. Today is the first time I am looking into this and I was happy to see that others like yourself have made the decision to do something about their breast.

  8. Avatar
    Kathleen January 3, 2019 at 1:11 am - Reply

    With breast shrinkage 4 years after lumpectomy my breast has shunk half it’s size and skin has darkened.and hard ..I feel half a woman .
    Is this normal ..

  9. Avatar
    Barbara Hawn January 23, 2019 at 6:31 am - Reply

    I’m 10 years post lumpectomy. There is a big difference in my breast size now. I’m wanting to have something done, just not sure what.

  10. Avatar
    jen February 5, 2019 at 11:56 pm - Reply

    My surgeon has suggested I have the reconstruction on the same day as my lumpectomy and lymph node removal. My breasts are relatively large, so going down some in size on both breasts could be a blessing. I’m trying to decide now what cup size to shrink to. The reduction, plus getting them lifted, is a way of trying to make lemonade out of the lemons of needing a lumpectomy in the first place. Though I must say, the surgery still has me super nervous overall. Will be doing radiation after I heal and have been told to expect some shrinkage in the radiated side. In some ways, I feel like waiting on the cosmetic part, yet have been told the radiation will affect the tissue, making it better to get the reconstruction beforehand.

  11. Avatar
    Kim February 23, 2019 at 5:07 am - Reply

    Thank you for the information. I am having a lumpectomy next week. After a year, I would like a breast reduction.

  12. Avatar
    Jeannie May 30, 2019 at 8:50 pm - Reply

    I will be going through the lumpectomy and breast reduction/lift very soon. I am large breasted and they will be taking a good amount of tissue. The plastic surgeon plans to leave the breast w/o radiation a bit larger to accommodate the shrinkage of the affected breast post radiation. They have a good idea how much your breast will change post radiation.

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