Is breast reconstruction always necessary?

Breast reconstruction is not always necessary since considerable improvements have been made in the ablative procedures. In contrast to the highly aggressive methods at the beginning and middle of the last century, when large portions of the breast and chest wall were removed (fig. 1, Halsted procedure), in recent years, there has been a trend towards less aggressive mastectomies (fig. 2, modified radical mastectomy) and more limited resections.

Fig. 1 Fig. 2

These more limited resections are referred to as “breast-conserving surgery” or “breast conservative therapy”: only a small segment of the breast is removed and the remaining breast is irradiated (tumorectomy ** segmentectomy). In some cases an acceptable aesthetic result can be achieved (fig. 3), but if patients are very sensitive to irradiation, the scarring and fibrosis of the remaining gland and overlying skin can cause a significant breast deformity (fig. 4). In addition, breast conserving surgery cannot be performed in all patients. In individuals with a small breast, or those who have a large tumor, a mastectomy remains the gold standard and frequently better results can be achieved when a mastectomy is combined with an immediate breast reconstruction.

Fig. 3 Fig. 4

Assuming there are no contraindications, the decision on whether to undergo breast reconstruction should be entirely up to the individual. Outcomes of patients who undergo reconstruction, are similar in patients who choose not to. In addition, breast reconstruction patients do not have an increased risk of developing recurrence or metastases and will live just as long as non-reconstructed patients.

In our experience, patients dealing with the initial shock and fear of a breast cancer diagnosis, tend not to consider the aesthetic implications of treatment. They only realize the full impact of this with the passage of time, as the shock and fear subsides. Receiving information about breast reconstruction before undergoing surgery and having a simultaneous cancer resection and breast reconstruction, can give a superior aesthetic result, without reducing the effectiveness of the oncological treatment.

Every patient has a choice:

  • Yes, I would like to have breast reconstruction
  • No, breast reconstruction is not for me, but I would like to know the other options available