What Options Do Patients With Breast Cancer Have After Mastectomy?

Mastectomy can have major impacts on the life of a person with breast cancer, from body image issues to sexual and psychosocial well-being, many of which are caused or amplified by mastectomy. Counselling patients on what their options are after mastectomy, including reconstructive surgery, is an essential part of cancer treatment and should be included in comprehensive treatment planning, according to Mark S. Lin, MSN, FNP-BC.

Lin, who shared a presentation of reconstructive plastic surgery at the nursing track of the 43^rd Annual Miami Breast Cancer Conference, emphasized that breast reconstruction, if patients choose to receive it, should not interfere with cancer treatment and is mandatorily covered by insurance. Reconstruction can be performed at the time of mastectomy or after adjuvant therapy.

Lin highlighted that there are 3 main paths a person with breast cancer can choose after mastectomy: implant-based reconstruction (IBR), autologous-based reconstruction (ABR), or no reconstruction. If patients opt out of reconstructive surgery, they may choose to use an external breast prosthesis, sometimes using a mastectomy bra.

Implant-Based Reconstruction

Patients who choose IBR will have an internal breast prosthesis such as a tissue expander and/or a silicone or saline implant. Silicone implants, Lin explained, are more common because they feel more natural compared with saline implants.

IBR offers a shorter operative time than ABR as well as shorter hospital stays and recovery. However, IBR is often “staged,” meaning it requires an initial operation to place an expander before a second surgery to replace the expander with the implant.

A tissue expander has a port that allows for the device to be expanded using a small needle inserted into the skin, which usually begins around 2 weeks after the initial expansion placement and may be continued for several weeks until the expander reached the desired size.²

Sometimes fat grafting via liposuction from the abdomen, flanks, or thighs will be used to improve the appearance of the reconstruction during the implant placement surgery. For patients who received a unilateral mastectomy, the remaining breast may be modified through a breast lift or reduction at the same time as the implant is placed.

Risks of IBR include long-term complications due to having a foreign object in the body, such as capsular contracture and rupture; infection; and implant loss.¹ Nurses should also note that implants do not last forever.

Alternatively, patients may receive a direct-to-implant (DTI), or single-staged, implant surgery. When patients receive DTI, a permanent implant is placed at the time of mastectomy. Patients’ eligibility for DTI is dictated by breast size, skin quality, and other patient factors.

Radiation therapy significantly increases the risk of capsular contracture and possible skin breakdown; if patients receive radiation and IBR, their reconstruction will typically be staged rather than DTI.

Autologous-Based Reconstruction

If patients opt to receive ABR, autologous flaps harvested from a second surgical site are transferred to the breast defect caused by mastectomy. According to Lin, ABR provides a “more natural appearance and feel” because living tissue is used. There are fewer long-term complications associated with ABR compared with IBR, and closure of the abdominal donor site is similar to an abdominoplasty.

With ABR, the tissue used lasts forever and is associated with higher satisfaction and is the preferred method for those who undergo radiation therapy, as it is generally better tolerated than implants and is often an option following the completion of radiation.

ABR required a longer operation and recovery time, with a 3- to 5-day hospital stay and 4 to 6 weeks of recovery. Patients receiving ABR also risk flap failure and will have donor site scarring. Of note, ABR required autologous tissue reconstruction candidacy.

Donor sites for ABR include deep inferior epigastric perforator, latissimus dorsi flap, profunda artery perforator, and superior gluteal artery perforator.

Lymphedema After Breast Reconstruction

Lymphedema, a chronic condition in which patients experience swelling in the arm, breast, or chest wall due to an abnormal accumulation of protein-rich lymphatic fluid, is common after breast cancer treatment. It is a result of damage to the lymphatic system from surgery, radiation, or both, and is most common in patients who have received a mastectomy.

According to Lin, frequent breast cancer-related causes of lymphedema include axillary lymph node dissection (ALND) alone (20% to 25% chance), ALND with radiation (33% chance), radiation alone (20% to 22% chance), and sentinel lymph node biopsy (0% to 7% chance).

Lymphatic microsurgical-preventing healing approach (LYMPHA) is a method of lymphedema prevention whereby prophylactic bypass of transected lymphatics to nearby venous outflow tracts is performed at the time of cancer-related axillary lymph node dissection.^1,3 Patients may receive LYMPHA to help prevent the development of lymphedema.

References

1. Lin MS. The art and science of reconstructive plastic surgery. Presented at the 43rd Miami Breast Cancer Conference; March 5-8, 2026
2. Tissue expander & implant reconstruction. UC Davis Health. Accessed March 13, 2026. https://health.ucdavis.edu/plasticsurgery/procedures/tissue_expansion.html
3. Lipman K, Luan A, Stone K, Wapnir I, Karin M, Nguyen D. Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention after Axillary Lymph Node Dissection-A Single Institution Experience and Feasibility of Technique. J Clin Med. 2021;11(1):92. Published 2021 Dec 24. doi:10.3390/jcm11010092