A team approach
Breast cancer surgery is led by your general or breast surgeon. Reconstruction is a separate set of decisions that are best made early, with both surgeons planning together. Dr. Jaberi works with general surgeons on combined cases at Queensway Carleton Hospital (QCH), so the mastectomy and the start of reconstruction can happen in the same operation when that is right for you.
Your cancer treatment always comes first. Reconstruction is planned around it and never delays what you need.
Timing options
Reconstruction can be immediate, which means it begins at the time of mastectomy, delayed until treatment is complete, or staged. The right timing depends on the type of cancer, whether radiation is expected, your health and your preferences.
- Immediate: begins in the same operation as the mastectomy
- Delayed: done after cancer treatment, including radiation, is finished
- Staged: a temporary step first, then the final reconstruction later
- Choosing not to reconstruct is also a valid decision, and some people prefer a flat closure
Types of reconstruction
Options include implant-based reconstruction, sometimes with a temporary tissue expander, and the use of your own tissue. Fat grafting is increasingly used afterwards to soften edges, correct dents and improve contour. Radiation can affect how tissue heals and which approach is best, so it is part of every plan.
A nipple-sparing or skin-sparing mastectomy may be possible for some people, which can allow a more natural result. Whether it is safe depends on the cancer and is decided together with your cancer surgeon.
Finishing touches
After the main reconstruction there are often refinements, such as fat grafting, matching the opposite breast, and rebuilding the nipple and areola. See our articles on nipple reconstruction and on breast preservation trends.
Cost and coverage
In Ontario, breast reconstruction after mastectomy for cancer is generally a publicly funded service. Coverage rules for particular procedures or revisions can vary, so confirm the details with your surgical team.
How to start
Ask your general surgeon about meeting a plastic surgeon before your mastectomy. You can also contact us to discuss your situation. A referral may be needed for hospital-based care.