Unhappy With Breast Reconstruction After a Mastectomy?

Breast reconstruction after a mastectomy can be physically and emotionally difficult. It’s made worse when the results aren't right. You might be unhappy with your breast reconstruction after a mastectomy for reasons like numbness, scarring, discomfort during exercise, drooping breasts, wrinkling, and more. 

While some issues improve within the first year after reconstruction, you should talk to your surgeon if you are still unhappy with the results. Another surgery may not always be the answer, but it is common for women to have one or more corrective surgeries before seeing their desired outcome. 

About Breast Reconstruction

Breast reconstruction after a mastectomy (removal of breast tissue to treat or prevent breast cancer) helps restore the look and feel of breasts. It is an elective procedure that helps some people with breasts maintain their emotional and sexual health while battling breast cancer.

Reconstruction often begins with a mastectomy but is rarely completed in one surgery. Instead, it typically requires a staged approach involving multiple surgeries over several months. For many, it’s a lifelong process, especially when involving implants. Some people also need unexpected corrective surgeries to get their desired results or to correct complications.

What Is the Regret Rate for Mastectomies?

In general, most women with cancer who opt for a mastectomy do not regret the surgery, though some do. Those who choose a bilateral (double) mastectomy are the least likely to regret their decision.

Research published as a survey of more than 1,500 women found that 22 percent of participants experienced regret of more than 25 on a scale of 0 to 100. Only 15 percent of participants who had a double mastectomy expressed regret.

Common Problems 

Sometimes individuals are unhappy with their results right after reconstruction. For others, time changes their results, leading to dissatisfaction. Regardless of the timeframe, common problems after breast reconstruction include:

• Numbness or lack of sensation due to breast tissue removal removing or cutting sensory nerves that typically run through it
• Different size than expected, simply because you imagined something different or because your healthcare provider made an adjustment
• Visible indentation at the tops of the breasts after removing tissue that once filled out the skin fully
• Heavy or drooping breasts when heavy implants pull on the skin
• Prominent scarring, whether due to surgical technique, genetics, or even your age
• Asymmetry (uneven breasts) due to complications, the surgical technique, or the healing process
• Breasts that are too far apart or too close together
• Dimpling or wrinkling in implants if the implant isn't fully supported by the surrounding tissue
• Discomfort, especially during exercise, whether during the healing process or because of a larger implant following the surgery
• Distortion when flexing chest muscle (with subpectoral implants)
• Loose skin if there isn't enough tissue or implant to fill the breast area
• Loss of the areola and nipple, although reconstruction is an option
• A nipple that looks or feels unnatural (after nipple-sparing mastectomy)
• Thickening or tightening (especially after radiation)

Talk to Your Surgeon

If you are unhappy with the results of your reconstruction, talk openly with your plastic surgeon. Expressing concerns may also shed light on complications that need correcting.  

Some concerns, such as wrinkling or swelling, often resolve in the months following reconstruction. It can take six months to a year for implants to settle into place. In these cases, your surgeon may advise you to wait before deciding on corrective surgery. 

However, they may provide you with corrective breast reconstruction options. These options can vary based on the type of reconstruction, radiation therapy, the size of your breasts, and body type. 

Get a Second Opinion

While it’s a good idea to talk with your plastic surgeon about your options, getting a second opinion is always OK. Specific geographic regions may offer corrective techniques you can’t find in your area, requiring you to travel to find one that offers advanced reconstruction options. Check with breast cancer online forums or support groups for suggestions.

Consider Your Options

Your options will depend on your unique case. Your surgeon may recommend corrective surgery, waiting, scar creams, or accepting your breasts as they are. It helps to weigh each option's positive and negative aspects.

Some things to take into consideration include the following:

• Whether the benefits outweigh the risks
• Your overall health
• Smoking status (quitting smoking helps with healing)
• Where are you in your treatment plan (f you need radiation, you may want to wait until after treatment)
• Recovery time
• Travel
• Cost 
• The possibility of needing more surgeries

Corrective Surgery

Often, corrective plastic surgery can fix cosmetic concerns. In some cases, your healthcare provider may even be willing to re-do your breast reconstruction. Your options will vary based on your previous reconstruction and how you healed.

Some common corrective surgeries include:

• Breast lift: This can help with concerns such as nipple placement, uneven breasts, drooping breasts, or loose skin. 
• Breast reduction: This decreases the size of the breast. It can be done with implants and autologous reconstruction (transplant from your body tissue).
• Skin tightening: Skin tightening may help reposition the nipple or breasts or fix droopiness and loose skin. This technique may involve surgical mesh, which gives support like an internal bra.
• Nipple repositioning and reconstruction: The surgeon may move or reconstruct a new areola and nipple from somewhere else on the body.
• Nipple tattoo: This gives the appearance of an areola and nipple from tattoo ink. Some people choose to have a decorative tattoo to cover the area or scars. Check with your plastic surgeon to ensure you are well-healed before the tattoo. 
• Fat grafting: Grafting is the injection of fat from a different area of the body, such as the abdomen (belly). It can help in various situations, including thick, toughened skin from radiation or obvious indentation.
• Replacing implants: The surgeon may replace implants with another implant or autologous (self) tissue if the implant ruptures or moves out of their pocket. It may involve reattachment of skin to the breastbone or artificial mesh to keep the implants from moving.
• Pectoral revision: The implant gets moved from behind the pectoral (chest) muscle to the top of the muscle. It can be helpful for those who have discomfort during exercise or don’t like the appearance of how the chest muscle pulls. 
• Scar revision: This may be an option when the mastectomy scar is large, very noticeable, or gets rubbed by clothing. 
• Capsulectomy: Surgical removal of hardened tissue that forms around breast implants (capsular contracture)

Accepting Your Breasts As They Are 

Sometimes the best option is to wait for a few months to see if swelling, wrinkling, or settling solves the problem. This is especially true right after reconstruction.

Additionally, you and your healthcare team may devise an alternative solution that works for you. For example, some people use padding or a breast prosthesis on one side to help with unevenness. 

For some, the risk of corrective surgery may not outweigh the benefit. In this case, some people accept their breasts for what they are. 

Complications 

Complications differ from unhappiness with your reconstruction results and must be addressed immediately. Complications after surgery include things such as:

• Bleeding 
• Seroma (fluid accumulation)
• Poor wound healing
• Infection
• Necrosis (death of tissue or fat) 

There is an ongoing risk for complications such as:

• Implant displacement (implant shifts too low, too far apart, or too close together)
• Capsular contracture (scar tissue forms around the implant, making it tight)
• Implant rupture
• Implant extrusion (the surface of the implant or expander is exposed) 
• Hernia (after a flap reconstruction)

Symptoms of complications after breast reconstruction include: 

• Breast pain or discomfort 
• Increasing tightness or firmness 
• Changes in the shape, size, or position of the breast 
• A lump or area of firmness in the breast
• Bulging or pain at the flap donor site

Summary 

Breast reconstruction after a mastectomy is an elective surgery that helps restore the look and feel of breasts. Some people with breasts may be unhappy with their initial results or with changes that occur over time.

Common concerns include more scarring than expected, breasts that look or feel too small or too big, loose skin, discomfort during exercise, and more.

While more surgery is not always the answer, breast reconstruction can be lifelong and corrective surgeries are common.