Today, if you have breast cancer, you can often elect to have surgery that spares much of the breast tissue. If you must have, or choose to have, a total mastectomy, you then have the option to undergo breast reconstruction.

Breast reconstruction uses tissue or implants to rebuild a normal breast shape so both breasts look balanced when you are wearing a bra. For some women, breast reconstruction improves their body image and self-esteem following cancer. If you do not chose reconstruction, you can wear a form inside your bra (prosthesis) to create the appearance of normal breasts.

You can undergo breast reconstruction at the same time as your mastectomy, or at a later date. Your eligibility for immediate breast reconstruction depends on the size of the tumor, your overall health, and, of course, your personal preference. Radiation therapy following surgery can change the tissue used for reconstruction, prompting some women to wait until after they complete treatment.

For many women, breast reconstruction helps them psychologically heal from the trauma of cancer. Although there are no clinical trials on breast reconstruction, physicians believe existing data favors immediate reconstruction, in part, because it spares women the experience of waking from surgery with no breast.

There are two ways to reconstruct a breast: using a synthetic implant or using tissue from another part of your body (autologous). Physicians prefer autologous reconstruction when possible because it's more natural and reduces the chance your body will reject an implant. Reconstruction replaces the lost bulk from the breast, and if the cancer or surgery permanently damages the skin, your plastic surgeon will replace it as well. You can add a nipple to your reconstructed breast.

During an autologous reconstruction, your surgeon will remove excess skin and fat from another part of your body-usually the back of the shoulder blade, the abdomen, inner thigh, or buttock area-to create a flap. Using a flap from abdominal tissue is a good option cosmetically and holds up better if you need subsequent radiation therapy.

Breast implants are made of silicone, gel, or tissue. After your physician surgically places the implant, she'll gradually expand it with saline until you reach the desired breast volume. The rate of complications following reconstructive surgery is higher with synthetic implants.

In 2007, only about 20 percent of women opted for breast reconstruction following a mastectomy. Women under 40 were most likely to opt for immediate reconstruction.

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