shutterstock 1407724754 (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.* 

Because breast cancer awareness has become so mainstream in recent years with everyone from celebrities to the NFL dedicating time and resources to supporting the cause, men and women alike are increasingly aware of the warning signs. Women especially are encouraged to regularly conduct their own self-breast exams and may even ask their partners to let them know if they notice any changes, too. 

But what happens if/when you find a lump? Because breast cancer has such a high profile and statistics like *one in eight women will be diagnosed in their lifetime* are well known, people are often fearful to seek medical advice after noticing a change in their breast tissue because they assume the worst. 

While it is absolutely essential to get any changes checked out by a medical professional, it is also important to remember that 80 to 85 percent of lumps found in women under the age 40 are benign and caused by fibrocystic changes, cysts, fibroadenomas, or fat necrosis to name a few.

With this in mind, it is important to understand the function and importance of breast exams. We’ve already shared the resilient stories of mastectomy patients ([HERE](https://aedit.com/aedition/mastectomy-breast-cancer-experience-from-patient-perspective)) and those who have undergone breast reconstruction procedures ([HERE](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer)), and in this article, The AEDITION speaks to women who found a lump and decided to do something about it.

## __Breast Check Basics__
For women with no family history of breast cancer, [the American College of Obstetricians and Gynecologists advises](https://www.acog.org/patient-resources/faqs/gynecologic-problems/mammography-and-other-screening-tests-for-breast-problems) people in their twenties and thirties have a breast examination carried out by a healthcare provider every one or three years. The American Cancer Society, meanwhile, [recommends annual mammograms](https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html) for women between the ages of 40 and 55. Women over 55 can switch to mammograms every two years or continue with yearly screenings. But that doesn’t mean you should just sit around for your next trip to the gynecologist. 

Women are encouraged to conduct a self-examination about once a month. Because benign lumps are known to appear over the course of a woman’s menstrual cycle, it is best to perform the exam at the same time every month — ideally a few days after your period ends.

During the exam, it is important to be on the lookout for any changes in the appearance of both the exterior breast (skin, areola, and nipple) *and* the interior tissue. Things to feel and look for include:

- A visible change in the shape or size of the breast or nipple
- A change in how the breast skin looks or feels (think: dimpling or puckering) 
- Soreness, redness, or rashes on the breast or underarm area
- Any areas that are visibly different compared to the rest of your breast tissue
- A lump (can be a small as the size of a pea) that persists in the breast or underarm area

If you notice any of these symptoms or something just doesn’t feel like your version of ‘normal,’ it is time to consult a medical professional for a more thorough check. Chances are, it is simple to treat. But if it is breast cancer, early detection is key.

## __Patient Perspective__ 
There are no two ways about it: finding a lump in your breast or noticing some other change to the chest can be alarming. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who lived through a breast cancer scare about their experiences and why they encourage everyone to consult a doctor as soon as they notice something isn’t quite right.

### __Anna, 29, Los Angeles__ 

<Dialogue>
  <Question party={The AEDITION}>
    What caused you to become concerned about your breasts?
  </Question>
  <Response party={Anna}>
    I was at college and aware that I needed to check myself every so often. I didn’t check as often as I now know I should, but one day I was in the bathroom and found a lump. It was probably around the size of an olive. I panicked and decided I wouldn’t tell anyone. My theory was that if I ignored it, it would go away. I would prove to myself that it wasn’t anything serious. But after a while, it was still there. A family friend had been diagnosed with cancer recently, so I guess it was on my mind. I made an appointment to see my doctor. At that point, I was convinced the only thing it could be was cancer.
  </Response>
  <Question party={The AEDITION}>
    What happened during your doctor’s appointment?
  </Question>
  <Response party={Anna}>
    I explained to the physician that I found this lump and that I thought I might have breast cancer. I was so anxious, but the doctor took the time to listen to me while I gave my garbled version of events. She then checked the lump herself, which was uncomfortable, but it didn’t take too long. She then asked me whether I had any pain, whether it changed during my cycle, and whether or not I’d noticed any other symptoms. I was referred for an ultrasound — my doctor explained it would give her a clearer idea of what was going on — but she also took some time to reassure me that it could very easily be something simple to treat and not cancer at all.
  </Response>
  <Question party={The AEDITION}>
    What did the next steps look like for you?
  </Question>
  <Response party={Anna}>
    First of all, I told a friend, which was probably the best thing I did throughout the process. She was able to reassure me and she also came with me to my other appointments. I had the ultrasound quite soon after the first appointment. Again, it was uncomfortable in that I’m not keen on being naked in front of random people, but, other than that, it wasn’t painful or anything. About a week after that I went back to the primary care doctor, who explained to me that it was a cyst. Because it was filled with liquid and not solid, I didn’t even need to have a biopsy. She told me to keep an eye on it, and if it became painful, they could offer me some other treatment options. That was about four years ago now, and I haven’t had any problems since. I do check my breasts regularly though, and I’m such an advocate for people getting any concerns checked out quickly.
  </Response>
  <Question party={The AEDITION}>
    What advice do you have for someone who finds themselves in a similar situation?
  </Question>
  <Response party={Anna}>
    I would say do the brave, grown-up thing and get it checked. Don’t bury your head in the sand because, if it is cancer, that’s literally the worst thing you could do. I think the awareness we have of breast cancer is amazing now, but it can make finding an issue so scary because the first thing that comes to mind is cancer. I also think people should share their concerns. Chances are a friend has been through a very similar thing — especially by the time you reach your late twenties. I know so many people who have been through the same panic. It’s best to share with both friends and doctors.
  </Response>
</Dialogue>

### __Stephanie, 58, Texas__

<Dialogue>
  <Question party={The AEDITION}>
    What led you to believe you might have breast cancer?
  </Question>
  <Response party={Stephanie}>
    I was checking my breast, which I do regularly now that I’m older. I felt something a bit different on my right side — almost in my underarm area. I had a sinking feeling when I first felt it and managed to calm myself down enough to have a Google, which, in hindsight, was not my best idea. I was pretty sure what I found could be a sign of breast cancer, and, honestly, I was scared. It took me a few days to gather together the courage to get a consult, but I didn’t want to leave it because I know how important it can be to get a diagnosis as soon as possible.
  </Response>
  <Question party={The AEDITION}>
    What pushed you to visit a doctor?
  </Question>
  <Response party={Stephanie}>
    I think breast cancer awareness has reached this amazing level where most of us know to check ourselves and not to mess around with it if we do find something a bit suspicious. I gave myself a couple of days to accept the potential reality of the situation and went to see my doctor. I explained the situation, and he took a look. Fortunately, the office also has an ultrasound room and I was able to sit and wait for it to come available there and then. I was told I had a liquid-filled cyst, and I was booked in for a biopsy. A couple of days after the biopsy, I received a call from my doctor, who explained what it was. He told me that I had an oil cyst, which can happen when fat is damaged. It wasn’t cancer at all. He praised me for being so reactive when I found it and told me to go and get on with my life — but to keep on checking in the future.
  </Response>
  <Question party={The AEDITION}>
    Did you know about fat necrosis when you initially felt the scar tissue in your breast?
  </Question>
  <Response party={Stephanie}>
    I honestly thought I was well informed about all things breasts, but apparently I was not. I hadn’t ever heard of it. I think it’s really important that, as much as we now all learn about checking for cancer, we also get told about other, far less life-altering issues we could develop in that area. I think it can be reassuring — especially for younger people — to know there are other conditions out there. Finding out quickly can save a lot of stress, but it is also important if it is cancer.
  </Response>
</Dialogue>

### __Jennifer, 34, Miami__

<Dialogue>
  <Question party={The AEDITION}>
    Could you give us an idea of the symptoms that led to your concern?
  </Question>
  <Response party={Jennifer}>
    It happened not long before I stopped breastfeeding my daughter, so I was kind of acutely aware of what was going on with my breasts. One of them started to get a little painful and, over time, got somewhat swollen and warm. My main concern was getting it seen quickly. Not only was I in pain, but I was scared that if I left it, I could jeopardize my future with my daughter.
  </Response>
  <Question party={The AEDITION}>
    What was your experience like with your doctor?
  </Question>
  <Response party={Jennifer}>
    I went to see my daughter’s pediatrician for an appointment that had been booked for weeks. While I was there, I broke down in tears and explained what was going on. The doctor was so lovely. She told me it sounded like an infection called mastitis, which is super common for new moms. She explained to me that I just needed some antibiotics and to keep an eye on how it progressed. She was so sweet and completely understood why I was so worried about the situation. Since then, I’ve done a fair bit of research just out of curiosity, and it turns out there are so many breast conditions I had no idea even existed. I think it’s so amazing that cancer awareness pushes people to check themselves and to consult quickly. I’m certain it’s helping to save hundreds of lives every year.
  </Response>
  <Question party={The AEDITION}>
    What advice would you give to someone who is feeling worried about consulting a doctor about a concern they have with their breasts?
  </Question>
  <Response party={Jennifer}>
    I think the concern stems more from the fear of it possibly being something ‘big’ as opposed to the fear of consulting in itself. And I do think that people knowing there are other things the symptoms could point to — aside from cancer — is reassuring on that front. That being said, I think the urgency that has been created from awareness is crucial when it actually is cancer. I think, if you’re concerned, ask for help as soon as possible, but hold on to the fact that 85 percent of lumps and bumps that people consult about are not cancer at all.
  </Response>
</Dialogue>

AEDITION expert perspective-min

Patient Perspective Collection | The AEDITION

Patient Perspective

There are no two ways about it: noticing a change to your breast can be scary. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who experienced a breast cancer scare and did something about it. 

What To Do If You Find A Lump In Your Breast

shutterstock 383018863 (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

It is estimated that some 250,000 women in the U.S. will be diagnosed with breast cancer each year. More than half of these cases will require invasive treatment like mastectomy procedures. 

For many, surgical breast reconstruction is an important part of the treatment and recovery process (read our comprehensive guide to breast reconstruction [HERE](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer)). Just as advancements have been made to mastectomy techniques, similar progress has occurred in reconstruction. Life-like, three-dimensional tattoos now offer patients a non-surgical alternative to traditional areola and nipple restoration. These medical tattoo techniques allow patients to achieve natural-looking breasts after surgery, as well as treatment for conditions like burn disfigurement, scarring, and skin discoloration. 

## __What Are Medical Tattoos?__

Medical tattooing, also known as medical [micropigmentation](https://aedit.com/procedure/scalp-micropigmentation), is a technique that is used as part of restorative and reconstructive medicine to help patients regain the natural appearance of their post-surgical and post-trauma skin with tattoos. The method, which involves sterile pigments being injected into the top layers of the skin using a medical tattoo machine, can be used to treat a wide variety of cosmetic concerns that have resulted from injury or illness.

One of the most life-changing applications of the method is for areola and nipple reconstruction in patients who have had a mastectomy. The procedure, when carried out by an experienced practitioner, allows patients to have natural-looking breasts once again — without additional surgery. 

## __What Options Are Available for Nipple and Areola Reconstruction?__

The main decisions patients face when it comes to nipple and areola reconstruction is whether they wish to undergo an additional surgery, opt for a non-surgical approach, or settle on a combination of the two. 

In terms of surgical options, patients can have a nipple created using a flap of skin on the breast that is reshaped to mimic the natural protrusion of the area. A skin graft, meanwhile, is employed to recreate the areola. These procedures are typically classified as outpatient and performed under local or general anesthesia after the initial reconstructive surgery scars have healed. Patients can also have the skin flap nipple reconstruction without the areola restoration. In this case, the areola is tattooed when the wound has healed.

For patients who do not wish to have further surgery, they may choose to commission a personalized silicone prosthesis or opt for reconstructive tattoos. Not your average ink, the tattoos must be carried out by a highly skilled and specialized practitioner, who understands the anatomy of the area, in addition to having a deep understanding of the emotional impact of the process.

## __Ask the Expert__

[Dominique Bossavy](https://www.dominiquebossavy.com/) is a pioneer of the reconstructive tattoo field. Born and raised in France, she trained in Paris before establishing her practice in the U.S. Using her proprietary NanoColor Infusion technique, she works with clients in both New York and L.A., offering both medical and cosmetic tattoo services — including scar treatment, eyebrow microblading, and French lip blushing to name a few.

She works clients following surgery or trauma to help them feel like themselves again by improving the appearance of scars and other skin concerns, and her areola restoration has become an important part of the breast reconstruction process for post-mastectomy patients. Here, she tells The AEDITION about her technique and the life-changing impact her work has on cancer survivors.

__The AEDITION:__ *How did you start your career in semi-permanent cosmetics? How did that journey result in you honing the NanoColor technique you use today?*

__Dominique Bossavy:__ At first, I was a client who was interested in the services of semi-permanent cosmetics. Unfortunately, I ended up with a botched job on my lips, which looked like I had a dark, unsightly line outlining my lips. It was upsetting and disfiguring. I was looking to find something to enhance my lips and thought that the product and process were possible, but the execution was just not there. I knew that needed to be a way to use this process and this technology, so it was really my search to find someone to help me fix the unsightly black line around my lips that I found my mentor and my calling. I was in France and found someone who was, at the time, a leader in the field and she offered me an internship to learn the art of her trade and techniques. 

Although I loved the concept and was fascinated by it, I still hated the results, which were still too obvious and unnatural. Even training with the best in the field at that time, I felt the industry was unsuccessful at truly enhancing the real essence of a woman’s beauty. So, I was faced with the challenge to either find a different way or to quit the industry.

I took on the challenge and began to dissect the entire process — from the application process to the molecular breakdown of colors — and figure out why it looked so flat or why the colors always looked unnatural or eventually faded to unnatural colors. I wanted to find the best solution to enhance features — with undetectable definition, dimension, and dynamic — to highlight natural beauty. I researched every aspect of the procedure in-depth and collected valuable facts before creating my specific NanoColor Infusion techniques.

__The AEDITION:__ *What concerns are you able to address for patients using your NanoColor Infusion technology and tattooing technique?*

__DB:__ I have worked on solutions to several problems women face, including burn disfigurements, post-trauma and post-surgery scars, stretch marks, hypo- and hyper-pigmentation, vitiligo, and alopecia. I even recreated a trompe l'oeil version of a missing toe and toenail and have tattooed the cornea of a blind eye. When people come to me with a problem, I always do my best to be the solution — even if it has never been done before.

__The AEDITION:__ *How does the nipple and areola restoration work?* 

__DB:__ I use non-allergenic microparticles of custom-blended colors that are skillfully infused into the dermal layer of skin to simulate natural-looking or well-defined makeup. 

In cases of reconstructive breast surgery after mastectomy, the medical micropigmentation process is used to improve the aesthetic appearance of the nipple-areola complex. The application of flesh-colored pigments to the restored areas of the areola may be utilized either as a supplement to or as a less invasive alternative to the skin-grafting procedure that, for many years, was the only available method of restoring balanced coloration to the area. 

Scar removal or camouflage is key, as is the realistic appearance of the areola pigmentation with its nuances. No one has only one color or texture in their breast tissue, and there are veins, hair follicles, and other details that make each client unique too. 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/1x1Cvi2ILWXeH4VIjUA6CW/00397e001b465fd5e2337edbf2a3276e/Screen_Shot_2019-10-17_at_11.53.45_AM.png}>
  A before-and-after of Bossavy's trompe l'oeil 3D areola for a breast reconstruction patient.
</CaptionImg>

__The AEDITION:__ *What does the consultation and tattooing process entail?*

__DB:__ Usually, the process takes several visits to obtain the desired final result. First, I take measurements, assess the asymmetries, and draw the areola onto the woman's breast. Then, I pick the three colors necessary to create a three-dimensional effect. A topical anesthetic is then applied to the client's breast and, within 45 minutes to an hour, the work is complete. It takes about nine days to heal. A second session is scheduled at six weeks to perfect the work and sometimes a third appointment is needed for some additional layering of color or texture. 

__The AEDITION:__ *How realistic are the results?*

__DB:__ Areola pigmentation has come a long way. It is no longer a bullseye tattoo over the breast mound. I actually create a 3D nipple which gives the illusion of protrusion that makes the tattooed areola very realistic with some depth and details of color and texture. I also recreate the illusion of the Montgomery glands and texture of a natural areola. When I reveal the results to a client, the first reaction is stupefaction — they can't believe how real they look. In some cases, clients have said that they look better than the real one they had. 

__The AEDITION:__ *How do the tattoos impact clients’ confidence?*

__DB:__ When a person is diagnosed with breast cancer, it is one of the scariest times of their lives. It can change them completely, particularly physically. Once a person has beaten cancer, they can focus on rebuilding themselves emotionally and physically, so restoring their physical femininity definitely has a positive effect. This is the final step of breast reconstruction, post-mastectomy. The emotional toll of not having nipples is important. Often, at the time of the reveal, they are so overwhelmed by happiness, they start crying. They are elated and say they feel complete and like a woman again. 

Clients have told me that they are no longer reminded of what happened to them, and they are able to move on with their lives. In many cases, they are ready to live a normal life again — being able to undress at the gym, to go to the beach, or start a new romance. They all have one thing in common: They want to leave the past behind.

In this society of filters and social media perfection, the impact of losing vibrancy, beauty, femininity, and the original or natural beauty of features like breasts is even more painful. My work gives them back a sense of normalcy by giving them back what was taken away by a truly traumatic and life-changing situation. They feel like they can face mainstream society again with confidence.

The impact that this 3D nipple-tattooing has on body image, self-esteem, emotional wellbeing, intimacy, and relationships is undeniable. It's a very emotional experience for my clients, and I am proud to contribute in some way to helping erase the constant reminders of a bad chapter in their life. As an artist on a live canvas, my mission is always to recreate the look of normalcy as artistically and scientifically possible.

__The AEDITION:__ *Do you often hear from your clients after you finish working with them?* 

__DB:__ I do! "I never thought I would feel whole again" are not words to a song, but a common phrase I hear from the many women I have helped after breast cancer. It's a very emotional experience for my clients, being able to erase the constant reminder of a bad chapter in their lives. A client recently shared: "The 3D areola gave me my confidence back, which I needed after everything that happened. It made me feel more comfortable looking at myself in the mirror. Now I feel confident enough to date again and get on with my life."

__The AEDITION:__ *Do you foresee restorative tattoos becoming a more common part of the reconstructive and recovery process?*

__DB:__ Surgeons and doctors see valuable benefits with this procedure. It's also now a legal requirement to provide reconstructive procedures — medical insurance companies must cover the cost of the procedure. I am in touch with top cosmetic surgeons locally and globally who want to work in tandem to provide this service to their clients. Oncologists and cosmetic surgeons, nurse practitioners, physician assistants, and counselors all realize there is more to healing than just removing cancer. The emotional and physical scars are painful and are all part of the recovery process to be addressed.

AEDITION for men-min

Expert Opinion Collection | The AEDITION

Expert Opinion

Breast reconstruction is an important part of the breast cancer treatment and recovery process. Life-like, three-dimensional medical tattoos now offer patients a non-surgical alternative to traditional areola and nipple restoration.

Interview With Dominique Bossavy About Reconstructive Nipple Tattoos For Breast Cancer Survivors 

Inside The Life-Changing Industry Of Reconstructive Tattoos

yuliya-kosolapova-Zp0VSsp5c5M-unsplash (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back. *

Now that you have a better understanding of the physical and emotional toll of breast reconstruction and the importance of finding the right surgical team (read our overview of how to approach the breast and nipple reconstruction process [HERE](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer)), it is time to dive deeper into the surgical options that exist for post-mastectomy patients to reconstruct their breasts and nipples.

Generally speaking, there are two categories of breast reconstruction: implant-based and autologous tissue (a.k.a. “flap”) based. In some cases, a combination is used to achieve the most natural and symmetrical results. Similarly, there are two main types of nipple reconstruction. One involves tattooing alone, while the other is a hybrid of reconstruction and tattooing.

“I want all of my patients to understand their options so that they can make the best choice for them,” says Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), who performs hundreds of breast reconstructions a year. “And then my job is to give the best result I can under those constraints.”

Here, a comprehensive guide to the most common types of breast and nipple reconstruction.

## __Reconstruction With Breast Implants__

The most popular form of breast reconstruction, breast implants offer a shorter surgery and recovery time than other reconstructive procedures. Implant reconstruction can either be delayed (performed in the months following mastectomy) or direct (performed in conjunction with the mastectomy surgery), and medical advances — like skin-sparing mastectomies, cohesive gel silicone implants, and internal support technologies like [AlloDerm](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184054/) and [GalaFLEX mesh](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070449/) — have allowed surgeons to create increasingly natural-looking results.

Despite the popularity, the technique is not without fault. “The challenge with implant-based reconstruction is that there is no natural soft tissue of the breast to help camouflage and contour an implant or to help rearrange tissue and nipple position in the same way that you can when there’s native breast tissue,” says Dr. Unger.

With that in mind, it is important to understand the different facets of implant-based reconstruction.

### __Pre-Pectoral Implant Placement__

While [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) (both reconstructive and cosmetic) have historically been placed under the pectoral muscle to help achieve a more natural look, the trend is now toward pre-pectoral (read: over-the-muscle) placement. 

“Pre-pectoral implants allow for an easier recovery with less pain and discomfort,” says UCLA board certified plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449). Another perk? The lack of animation deformity. “When you have an implant under the pec muscle and you flex it, and it makes things look a little off,” he shares.

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/4kGyMFWGZDViCo4RyAozgb/7b738a9b9c468daccac9743810d02f07/JacobUnger__1_.jpg}>
A before-and-after of Dr. Unger's pre-pectoral breast reconstruction following a nipple-sparing mastectomy.
</CaptionImg>

Ideal candidates for [pre-pectoral placement](https://aedit.com/procedure/pectoral-implants) are those with younger, thicker skin, which better camouflages the implant directly below. Technique is also important. “Wrapping the implant in a dermal matrix (sterilized cadaver skin) allows you to contain the implant well and gives it an extra layer of coverage,” Dr. Roostaeian notes. “But the most important technique we use to disguise the implant is fat grafting.”

Rather than using an implant alone, plastic surgeons will often recommend a hybrid procedure that involves harvesting fat from a donor site (think: the belly, flanks, or inner thighs) to be injected around the breast implant. The result? Smoother and more natural-looking breasts.

“Fat grafting has changed the way I do breast reconstruction,” says Beverly Hills-based board certified plastic surgeon [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578). “It can improve the outcome of any breast reconstruction, creating a more natural appearance and giving me the ability to fine-tune my results in a way not previously possible.”

Additionally, Dr. Rogers has been having success with a new liposuction-alternative called [Renuva](https://www.mtfbiologics.org/our-products/detail/renuva). “Renuva is a biological allograft product that stimulates your body to grow its own fat cells,” he says. “This would be an ideal product for small contour irregularities after breast reconstruction as opposed to using a patient’s own fat.” 

### __Delayed Reconstruction Using Implants__

Depending upon a patient’s individual anatomy and treatment plan, he or she may choose not to combine their mastectomy and reconstruction procedures. Similarly, surgeons may recommend delaying the placement of permanent breast implants until a later date for better results. 

In such cases, tissue expanders are sutured into the breast pocket immediately following the mastectomy. In the weeks and months following the surgery, the expanders are gradually inflated in a plastic surgeon’s office using air or saline. “A tissue expander preserves the space where the breast needs to be,” says Dr. Unger. And, since placing a heavy silicone implant into an empty breast pocket would compress the fragile blood supply that remains post-mastectomy and lead to tissue death, he notes that the tissue expander “allows the mastectomy flaps to rest without putting undue weight there.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/QWzB5aIWpQK0olqHTiNQD/617149c0afa434bc6b455775044c2c95/dr_jason_plastic_surgery_breast_reconstruction_subpec_implant_f__2_.jpg}>
  A before-and-after of Dr. Roostaeian's unilateral subpectoral breast and nipple reconstruction.
</CaptionImg>

Although the expansion process can be uncomfortable, tissue expanders have the additional benefit of giving both plastic surgeons and their patients time to home in on an aesthetic goal. Once the expanders reach the appropriate size, they are exchanged for permanent breast implants. Dr. Roostaeian’s patient Caroline* (diagnosed at 39) admits that the expanders proved to be a necessary evil. “My expanders didn’t look natural, and were sometimes very painful after they were filled,” she recalls. “But they helped me get a really good idea of what size implants would ultimately be best for me.”

After years of monitoring benign tumors and then a cancer diagnosis at age 31, Dr. Unger’s patient Laura says she chose a nipple-sparing double mastectomy because of the quality of reconstruction available today. “I was tired of the breasts I had, but I wasn’t ready to give them up completely,” she confides. “I was really lucky because he was able to place the expanders on top of the muscle, which was a lot easier recovery for me.” 

Laura chronicled her journey on Instagram [@laura_birdwell](https://www.instagram.com/laura_birdwell/?hl=en) and her blog, [tatatocancer](https://tatatocancer.blog/), and, once her expanders were filled, Dr. Unger exchanged them for permanent implants and performed simultaneous fat grafting. Like many reconstruction patients, Laura then had an additional surgery to further refine her results. “I think they look better now than they did before,” she says of her breasts.

### __Direct-to-Implant Reconstruction__

In some cases, women can skip the expander step by having their permanent breast implants placed immediately after their mastectomy. With its promise of only one surgery (which means less anesthesia and recovery time), the direct-to-implant option is understandably appealing — though it’s not for everyone. 

According to Dr. Unger, good candidates are usually women with “smaller, ideally shaped breasts,” who “want to be close to the same size, are very healthy, and have very robust mastectomy flaps” (read: ample blood supply). 

Hayley, diagnosed at age 30, initially had a lumpectomy. “That gave me time,” she says of the procedure. “They got the tumor out, and found out it hadn’t spread.” In her search for a highly skilled surgeon with experience performing pre-pectoral, direct-to-implant reconstruction, Hayley found Dr. Roostaeian after interviewing five or six surgical teams.

During this kind of reconstruction, Dr. Roostaeian uses a new fluorescence imaging technology called SPY to evaluate blood flow right in the OR. “It’s another tool in our arsenal to help ensure the long-term success of the reconstruction,” he says.

Kelly, diagnosed at 45, opted for a unilateral mastectomy and immediate reconstruction with Dr. Rogers. “I had cosmetic implants, and I really liked how I looked before,” she shares. “Whether or not to have reconstruction was never a question in my mind.” 

She was able to undergo a sub-pectoral, direct-to-implant reconstruction, in part because she already had breast implants placed under the muscle. Dr. Rogers also replaced the implant in the non-cancer breast to ensure symmetry, and Kelly ended up having a couple of subsequent surgeries — including fat grafting and nipple reconstruction — for further refinement. Eight years later, she is still very happy with the results. “You can’t even tell the difference,” she says.

While there are plenty of direct to implant success stories, there is also risk. Because of the fragile nature of post-mastectomy skin flaps, many surgeons prefer the two-stage (expander followed by implant) process. “Everybody wants less surgery. Everybody wants to be done and have it behind them,” says [Michael Newman, MD](https://aedit.com/provider/michael-newman-md-795), a board certified plastic surgeon at South Bay Plastic Surgeons in Torrance, CA. “But it’s more important for me to give them a more durable, long-term result.” He prefers using a tissue expander because “it’s very light” and “doesn’t put any pressure on the skin or the mesh,” which “allows the sutures to heal.”

Additionally, the procedure is seldom as ‘one and done’ as it sounds. Patients almost always require additional surgeries to achieve their aesthetic goals. “Direct to implant is a nice concept,” says Dr. Unger, “But the vast majority of the time, you’re going to need to go back to the operating room to touch things up or round things out or add some fat.” 

## __Flap Reconstruction__ 

Autologous tissue reconstruction — more commonly known as “flap surgery” — involves the transfer of tissue from one area of the body (i.e. a donor site) to the chest to create a breast mound. Surgeons can either shift the tissue from one area to another, leaving the primary blood supply of the donor site intact (a.k.a. a pedicle flap), or completely remove the tissue from its original spot and reattach it to the chest in a free flap procedure. 

Free flaps require intricate microsurgery, during which plastic surgeons suture blood vessels together under a microscope to re-establish the blood supply between the donor tissue and the chest. It’s meticulous and time-consuming work (bilateral free flap surgeries can take up to 12 hours to complete), and patients are closely monitored in the hospital for up to five days post-op to ensure the flap is viable. 

The recovery process can be more complex than implant surgery because patients have multiple surgical sites to contend with (the chest and the donor area), though patients report similar pain and discomfort levels with each type of procedure.

### __Types of Flap Reconstruction__

Because of the donor site component, there are a variety of flap procedures for a patient to choose from based on their anatomy and aesthetic goals. The names are based upon the donor sites, including those from the abdomen (TRAM and DIEP), back or shoulder (LAT), inner thigh (TUG), and buttocks (GAP).

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/6tVaTrX0SELcdJYzGiEfbF/430d029fe1f2c807e002d916c354e783/10-16-2019_Editorial_Before-After_BreastReconstruction.jpg}>
  A before-and-after of Dr. Newman's bilateral DIEP flap breast and nipple reconstruction.
</CaptionImg>

Among the plastic surgeons we interviewed, the most popular flap surgeries are the latissimus dorsi (LAT) flap and the deep inferior epigastric perforator artery (DIEP) flap. While a LAT flap is often used in conjunction with a breast implant reconstruction for better results, the DIEP is a free flap procedure that removes abdominal skin and fat only (similar to a tummy tuck) to create a breast mound. 

#### __LAT Flap__
- __Donor Site__: Composed of muscle, skin, and fat from the back
- Type of Flap: A pedicle flap (it remains attached to its primary blood supply)
- __Scarring__: Creates a donor site scar along the back that can usually be concealed in the bra line and an oblong scar around the new breast mound
- __Surgery Time__: 5 to 7 hours, on average 

#### __DIEP Flap__
- __Donor Site__: Composed of skin and fat (no muscle) from the abdomen
- __Type of Flap__: A free flap (it is completely detached from its original blood supply)
- __Scarring__: Creates a donor site scar between the hip bones (similar to a cosmetic tummy tuck) and an oblong scar around the new breast mound
- __Surgery Time__: 8 to 12 hours, on average

### __Advantages of Flap Reconstruction__

While flap procedures are more complicated to perform and require longer surgery times, Dr. Roostaeian says they remain the “gold standard” for breast reconstruction because they create a result that most closely resembles and behaves like a natural breast.

Unlike an implant, the new breast mound feels more like a natural breast because it is created with the patient’s own fat and skin. In the case of unilateral reconstruction, the plastic surgeon will be better able to match the new breast to the unaffected breast. Additionally, breasts created from flap procedures can fluctuate in size and shape as a patient gains or loses weight. 

“Flap surgery is ideal for patients who’ve opted for unilateral reconstruction because that flap changes with your body,” says Dr. Roostaeian, who adds that the results are, long term, much more permanent than implants. “When you choose the implant route, you’re basically signing up for more surgeries in your life because implants tend to have some issues down the road.”

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/35Yvu4Q4Y1iyJmiDjQDUHU/9a54e787069024a30d7755bb2ce90c84/Flap_Reconstruction__1_.jpg}>
  A before-and-after of Dr. Rogers' unilateral flap breast and nipple reconstruction.
</CaptionImg>

That lack of future revisions led Marjan, one of Dr. Roostaeian’s DIEP flap patients who was 47 at the time of her surgery, to choose the procedure. “I told him that because I was young, I didn’t want to have to go under the knife in my seventies,” she recalls. 

Dr. Rogers’ patient Meredith* didn’t want breast implants because she thought they’d look unnatural and possibly interfere with her active lifestyle. “When Dr. Rogers explained that the DIEP procedure would be a tummy tuck — replacing my breasts with my own tissue — and I wouldn't have implants, I was all in,” she shares. “I knew it would be a long 12- to 13-hour surgery the day of, but I was ready to go for it.”

Though she was initially concerned about scarring and the longer recovery time, Meredith is “beyond satisfied” with her reconstruction. And, with her nipple reconstruction also complete, she says her breasts appear so natural that it looks like she had a [breast lift](https://aedit.com/procedure/breast-lift) and [abdominoplasty](https://aedit.com/procedure/abdominoplasty) (i.e. tummy tuck) — not a double mastectomy.

Flap surgery is also an option for women whose implant reconstruction failed due to radiation or persistent capsular contracture issues. Dr. Roostaeian’s patient Caroline originally had bilateral, implant-based reconstruction, but radiation damaged her tissue and caused healing problems. “Dr. Roostaeian told me that the only way to permanently address the situation was to have a DIEP flap,” she says. “It was daunting, and I didn’t think I had enough fat, but he was able to create a small breast and augment it with an implant. It’s so natural that I wish I’d had enough fat to do the other side too.”

## __Nipple Reconstruction__

While skin- and nipple-sparing mastectomies have become commonplace, the patient’s diagnosis may not always allow surgeons to keep the nipples intact. This leaves patients with two reconstruction options: tattooing alone or a combination of surgical reconstruction and tattooing. 

In the former, a medical tattoo artist matches the new nipple and areola to the existing one (after unilateral mastectomy) or creates two new nipple/areolar complexes based on the patient’s aesthetic preferences (after bilateral mastectomy). Shading and color variations help create the illusion of depth and projection.

Surgical nipple reconstruction, meanwhile, takes about 45 minutes and can be done either in conjunction with a follow-up reconstructive surgery or alone under local anesthesia. Surgeons use skin from the center of the breast to create a nipple, leaving a small horizontal scar. Patients can then have the areola and nipple tattooed for a more natural-looking color and to conceal any visible scarring.

## __The Takeaway__

Just as no two breast cancer diagnoses are the same, the reconstruction process is a deeply personal experience that patients may choose to undergo when it is most comfortable for them. With that said, understanding the options available prior to having a lumpectomy or mastectomy can ensure the patient ends up with the best results for their anatomy and aesthetic goals. Finding the right surgical team and seeking the support of women and men who have been through the experience can help to make sense of the process.  

*Patient names have been changed

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From immediate and delayed implant reconstruction to the numerous types of flap surgeries, The AEDITION has compiled an in-depth guide to post-mastectomy breast and nipple reconstruction.

A Comprehensive Guide To Breast Reconstruction And Nipple Reconstruction

A Comprehensive Guide To Breast And Nipple Reconstruction

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.* 

From the emotional toll to a whirlwind of appointments, testing, and treatment options, a breast cancer diagnosis can bring a flurry of confusion and fear. Each aspect comes with its own impact — not only on a woman’s health, but on her sense of self. Fortunately, early detection and advances in both technology and surgical techniques have created better breast reconstruction options that help patients to feel like themselves again. 

To better understand the intricacies of the mastectomy and breast reconstruction process, The AEDITION spoke to leading plastic and reconstructive surgeons and their patients about the logistical, physical, and emotional aspects of breast reconstruction — whether it’s finding the right surgical team, understanding what the results will look like, or learning how to heal (physically and emotionally) after surgery. 

## **Finding the Best Surgical Team**

Although it can be hard for a woman recently diagnosed with breast cancer to focus on the long term, the success of her breast reconstruction may ultimately depend on it. “Some patients are so focused initially on getting the cancer out that they don’t really explore the options for reconstruction,” cautions plastic surgeon [Michael Newman, MD](https://aedit.com/provider/michael-newman-md-795), of South Bay Plastic Surgeons in Torrance, CA. “But then they get to that stage when the cancer is out, they’re feeling better, and they really want a better result.” 

When that happens, they often try to find another surgeon, and Dr. Newman says he treats a fair number of patients seeking a revision after surgery elsewhere. While he is able to help the majority of such patients, it is not the most optimal way to do things. 

“There are a lot of breast surgeons who don’t leave the best tissue behind for the plastic surgeon to work with. When there’s a limited amount of tissue to work with, even the best plastic surgeon can’t do a great job,” he says. “It’s better to optimize their reconstruction from the beginning because they end up with a better final result.”

In order to do so, Dr. Newman recommends women take the time to find the best breast surgeon, so they can “set the stage for an ideal reconstruction.” In a perfect world, he says patients should visit a plastic surgeon at the outset to get a referral for a breast surgeon (though it generally happens the other way around). But, if a patient has already chosen a breast surgeon, Dr. Newman suggests asking her plastic surgeon if that doctor is someone they’ve worked with in the past.

The key, according to Dr. Newman, is to find a breast surgeon capable of achieving a balance between removing all of the breast tissue and leaving an adequate amount of skin, fat, and blood vessels behind to support the reconstruction. And he says you shouldn’t be shy about asking your breast surgeon about their experience level and their philosophy regarding tissue removal. 

Another piece of advice? Find support.

Dr. Newman advises women to seek out breast cancer support groups (often offered at hospitals) for advice on which doctors to choose. “When you talk to other people who have been through it, they’ve not only had their own experiences, but they’ve heard from other people too,” he shares. 

Once you’ve found your team, the next step is determining the best course of action for your diagnosis. 

## **Removing the Cancer: Lumpectomy vs. Mastectomy**

Deciding on a breast cancer treatment plan often depends on the type and stage of the cancer, the philosophy of the doctors, and the patient’s own goals and preferences. 

During a lumpectomy procedure, a breast surgeon removes only the tumor, leaving the rest of the breast tissue intact. Less invasive than a mastectomy, a lumpectomy may not have a noticeable impact on the size and shape of the breast — though a growing number of patients are opting to combine the procedure with aesthetic surgery.

“Women with very large breasts who are getting lumpectomy surgery sometimes are getting [breast lifts](https://aedit.com/procedure/breast-lift) or [breast reductions](https://aedit.com/procedure/breast-reduction) as part of that surgery,” says Dr. Newman. “It’s either to make them feel more comfortable, more symmetric, or to facilitate their secondary treatment such as radiation.”

Additionally, Dr. Newman has noticed that younger women are increasingly choosing to undergo a mastectomy — either unilateral (one breast) and bilateral (both) — during which the surgeon removes all of the breast tissue (read our comprehensive guide to the surgery [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer)). “As breast reconstruction results have improved, patients are more likely to move towards a mastectomy or even a double mastectomy than they had in the past,” he says. 

Historically, surgeons removed the breast tissue, nipple, and much of the skin, but the rise of nipple- and skin-sparing procedures have been game-changers for breast reconstruction results. During a nipple-sparing mastectomy, the breast tissue is essentially scooped out, leaving the outside of the breast (nipple and skin) virtually intact. “You don’t have to sacrifice the most difficult aspect of the breast to reconstruct,” says Nashville-based plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), of the technique. “To create a nipple, you either need to get a tattoo, which leaves no projection, or reconstruct one, which leaves scarring in the center of the breast.” 

According to Dr. Unger, who performs several hundred breast reconstructions per year, data shows that, in most cases, leaving the nipple and skin intact does not adversely impact a patient’s long-term prognosis — but it can do wonders for the post-surgery outcome. Sparing the nipple and concealing the surgical scar in the breast fold allows surgeons to create the most natural-looking results. 

## **Types of Breast Reconstruction**

Generally speaking, there are two categories of breast reconstruction: implant-based and autologous tissue (a.k.a. flap)-based.

- __Implant__: Most commonly used thanks to its shorter surgical and recovery time, implant-based reconstruction can be performed in conjunction with a mastectomy or at a later time and involves using an implant to recreate the breast. 

- __Autologous Tissue__ (a.k.a. Flap): In this procedure, the surgeon utilizes the body’s own tissue to construct a breast mound by transferring tissue from one area of the body (known as the donor site) to the chest.

Sometimes, a combination of the two is used to achieve the most natural, symmetrical results. “I want all of my patients to understand their options so that they can make the best choice for them,” says Dr. Unger. “And then my job is to give the best result I can under those constraints.”

Creating a natural *and* symmetrical result can be challenging — regardless of the type of mastectomy or breast construction technique performed. In patients who opt for a unilateral mastectomy with an implant, for example, it is difficult to match real breast tissue to the standard shape of an implant. 

A patient’s unique anatomy, meanwhile, can pose challenges for reconstruction after a bilateral mastectomy, too. “People aren’t always even between their two sides,” UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), points out. “We want the best aesthetic results, but there are a lot of variables out of our control: how the mastectomy was performed, whether they are planning to have radiation, the structure of their ribcage — all of these things that nobody really ever thinks about.”

While surgeons take all of these nuances into account, there’s no such thing as perfection. In fact, relying solely on measurements — particularly for things like nipple placement — can leave a patient with an unnatural result. “The good news is that since nobody is perfectly symmetric, it’s more about making each breast look good on its own,” says Dr. Roostaeian. “They are sisters, not twins.” 

Ultimately, the surgeon’s well-trained eye is paramount because the reconstruction process is equal parts art and science, and managing a patient’s expectations is key. “Women who are undergoing breast cancer care today are expecting and hoping for results similar to aesthetic breast surgery,” says Dr. Unger. “It’s about having appropriate expectations and having good lines of communication.”

## **The Emotional Impact of Breast Reconstruction**

While a successful breast reconstruction can have a tremendous impact on helping women start to feel whole again after a cancer experience, the path isn’t always smooth or linear. It is not uncommon for reconstruction patients to experience some degree of post-surgery depression and seeking help through support groups or therapy can make a big difference. 

Dr. Roostaeian’s patient Marjan was ultimately very happy with her flap surgery, but it was emotionally challenging at first. “I started getting really emotional,” she says of her experience, which included a flap procedure, refining surgery, and nipple reconstruction. “I was regretting not getting the double mastectomy because I was afraid I’d have to go through all of this again.”

Initially, she says that every time she saw herself in the mirror, her unaffected breast reminded her of what she’d lost, but Marjan sought therapy and eventually came to terms with her new appearance. “I changed my perspective, my outlook on body image,” she shares. “When I see people now who look different, it doesn’t phase me. It’s just normal.”

Hayley, meanwhile, chose a pre-pectoral, direct-to-implant reconstruction in part because she wanted to be done with the process sooner. “I wanted to move on with my life, to feel like my old self again,” she says. But months after her treatments, Hayley experienced symptoms that her oncologist said were long-lasting side effects of everything her body’s been through. “Even though I know that I’ll never truly be my old self after going through something really scary, I grew a lot from it,” she says of her experience.

Caroline* also went through a period of conflicting emotions after her reconstruction. “It hit me at the end,” she says. “You’re so focused on getting through all of the terrible parts — mastectomy, chemo, radiation — to reach this goal of reconstruction, and, when you get there, you have to come to terms with the fact that no matter how well they put you back together, it’s not the old you. You have to learn to embrace the new you.”

One thing that can help give patients peace of mind is knowing that they had the best care. Dr. Unger’s implant reconstruction patient Laura, who chronicled her breast cancer journey on [Instagram](https://www.instagram.com/laura_birdwell/?hl=en) and her [blog](https://tatatocancer.blog/), says that finding the right plastic surgeon helped her get through an otherwise incredibly challenging time. “When you’re going through everything, and you’re losing your hair, it’s just such a comfort,” she says. “I call him ‘the good doctor.’”

Kelly feels the same way about the rapport she built with her own plastic surgeon, [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578). “It’s really important to educate yourself and to find someone you trust,” she says. “It’s a relationship, not a ‘one and done.’” 

*Patient names have been changed

The AEDITION speaks to leading plastic and reconstructive surgeons and patients about the logistical, physical, and emotional aspects of breast reconstruction — from finding the right surgical team to learning how to heal after surgery. 

How To Approach The Post-Mastectomy Breast Reconstruction Process

How To Approach Post-Mastectomy Breast Reconstruction

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

[According to the World Cancer Research Fund](https://www.wcrf.org/dietandcancer/cancer-trends/breast-cancer-statistics), breast cancer is the most commonly occurring cancer in women worldwide and the second most common cancer overall globally, with two million new cases in 2018. In the United States, [it is estimated](https://www.breastcancer.org/symptoms/understand_bc/statistics) that one in eight women (or approximately 12 percent of the female population) will be diagnosed with breast cancer in her lifetime. 

The mastectomy plays a large role in the prevention and treatment of breast cancer, and, while The AEDITION has covered what to expect before, during, and after the surgery from a medical perspective (more on that [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer), calling attention to the emotional toll of choosing to remove one or both breasts is just as important.

Here, two women share their deeply personal and resilient experiences with breast cancer, mastectomies, and breast reconstruction. 

## __Rena, 53__
In a six-month period, Rena’s relationship with her body and her breasts completely changed. Her breast cancer diagnosis and subsequent unilateral mastectomy happened very quickly, and she was forced to face her new reality much sooner than expected. Rena made the decision not to undergo breast reconstruction and quickly learned that the subsequent transformation was more emotional than physical. 

“The emotional scars take much longer to heal than the physical scars do,” she shares. “The breasts are symbolic of so much. They’re symbolic of feminine beauty and motherhood. Breasts come with a lot of baggage.” 

Following her mastectomy, Rena felt deep waves of emotion that resembled grief, pain, and sadness. “There was a point after the mastectomy where I genuinely thought I was losing my mind because I was so sad. I felt so unwell. I was in a lot of pain. I didn’t really want to leave the house,” she recalls. “And now I look back at that and go, ‘Of course.’ Grief is going to come your way, and you can name it. Now if I feel sad, I go, ‘Oh yes, grief. I know what that is. It’ll be gone tomorrow. Just having a sad day.’ I don’t have that, ‘Oh my god, I haven’t just lost my breast, I’ve lost my mind’ feeling.”

<PullQuote attributedTo={Rena, 53}>
  “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”
</PullQuote>

Rena says the emotional labor was hard, but learning to sit with it and honor how she was feeling was key. She allowed herself to feel her emotions and didn’t pressure herself to feel strong all the time. The driving force of Rena’s recovery came when she stopped letting the situation control her and instead could respond to what was happening around her.

“Take control of what you can,” she explains. “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”

In the moments before her surgery, for example, Rena insisted on walking into the operating room instead of being wheeled in by the nurses. When she got home, she turned all the full-length mirrors in her house around until she decided she was ready to look at her body again. 

Her advice to those on a similar journey: “As soon as you get that news, the time is now to start saying goodbye to your breasts and thanking them for everything they’ve meant to you and done for you,” she says. “Quickly get it into your head that it’s your choice to do away with your breasts in exchange for your life. I chose to sacrifice my breast in order to live. I know that’s sad, but you can say, ‘I will be sad to lose my breasts, but I want to live.’”

## __Tracey, 45__
Like Rena, Tracey has been on her own unique journey. Her diagnosis was a long time coming because she knew she was at risk of developing breast cancer and was able to anticipate at least part treatment and recovery. Due to her family history of breast cancer, she was screened regularly for the disease and discovered she carried the BRCA1 gene mutation in late 2010. She decided she would preventatively have her ovaries removed and undergo prophylactic (a.k.a. preventative) mastectomy and breast reconstruction procedures at the same time.

“If I just had a mastectomy, I know I personally would not have felt feminine,” she shares. “Because I was doing elective surgery, I was lucky enough to be able to consider this option and have the two procedures done together.”

Opting for an immediate reconstructive surgery gave Tracey the opportunity to feel like she was reclaiming power over her experience, but, post-mastectomy and breast reconstruction, she experienced a series of complications and side effects that prolonged her recovery time.

<PullQuote attributedTo={Tracey, 45}>
  “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”
</PullQuote>

“A few days after the procedure, my cosmetic surgeon noticed that my right nipple wasn’t going to survive, so I had to be taken back in for surgery to remove it. After about a month at home, I got really sick due to an infection in the right breast, and I had to be rushed to the hospital to get the expander out,” she explains. “All up, I think I’ve had about six or seven surgeries now — this includes having the implants put in and a nipple reconstruction on my right breast, which looks great. My left breast is perfect and I’m happy with it. The right one, not so much. But who is ever happy with the way their breasts look? Even naturally, they’re different. I continue to see my plastic surgeon once a year for a follow-up.”

While her road to recovery was a winding one, she remains upbeat about the results. “I’m not affected by it from day to day. Yes, my breasts are hard, one is quite scarred, and one nipple is bigger than the other, but did I make the right decision? Absolutely, 100 percent,” she says. “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”

Tracey’s advice to anyone who is considering a preventative procedure or currently undergoing treatment: “I think it’s a personal journey. Everyone is different and has different feelings and expectations,” she says. “My only advice would be to ensure that you do go through all the options of the procedure, have a great surgeon, and surround yourself with a good support group and care team. Try to be positive as much as you can and reassure yourself with the reason why you’re going ahead with these procedures.”

## __The Takeaway __
Rena and Tracey’s experiences prove that there is nothing linear about breast cancer diagnoses and treatment, but hearing from survivors and those who have elected for preventive mastectomies helps to shine a light on the fact that — regardless of your circumstances — the experience is as emotional as it is physical. While finding board certified surgeons who you trust and feel comfortable with is paramount to your medical care, reading about other people’s journeys and creating a strong support system before, during, and after surgery can help to alleviate some of the emotional burden. 

While it is important to know what to medically expect from a mastectomy, understanding the emotional toll of choosing to remove one or both breasts is equally vital. Here, two women share their deeply personal and resilient experiences.

How To Take Control Of Your Mastectomy Journey From Patients' Perspective

How To Take Control Of Your Mastectomy Journey

shutterstock 737486260 (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to BCA, from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

We’re thinking pink! In case you needed an extra incentive to stock up on your favorite products or treat yourself to something new, brands are giving back all October long in honor of Breast Cancer Awareness Month. 

From pretty-in-pink lipstick duos and serious skincare to cozy blankets and blooming bouquets, there are plenty of ways to shop for the cause this month. The Estée Lauder Companies, for one, is back with its annual Breast Cancer Campaign benefitting the [Breast Cancer Research Foundation](https://www.bcrf.org/), which means brands like La Mer, Bobbi Brown, Rodin, Bumble and bumble, and more have released limited-edition versions of some of their bestselling products. Beautyblender is here with a special bubblegum pink sponge in support of the organization, while other brands are partnering with equally worthy charities like [Look Good Feel Better](https://lookgoodfeelbetter.org/), [Pink Agenda](https://www.thepinkagenda.org/), [Partners in Health](https://www.pih.org/), [B4BC](https://b4bc.org/), and the [American Cancer Society](https://www.cancer.org/).  

Keep scrolling to shop our favorite beauty, fashion, and lifestyle Breast Cancer Awareness finds below!

![ORIGINS](//images.ctfassets.net/zw35sfestf1t/3Y4bOe7bmH6RyOUjklfwDU/bdee3e9b0ed578bdcec6ac91987b9884/ORIGINS.jpg)
__Origins Think Bold Limited Edition Blooming Bold Lipstick Kit__
This botanical blend lipstick hydrates and conditions the lips while providing a full-coverage, satin finish. Oh, and 100 percent of the purchase price is being donated to the Breast Cancer Research Foundation. $20, [origins.com](https://www.origins.com/product/15374/68627/makeup/lips/breast-cancer-awareness-think-bold/limited-edition-blooming-bold-lipstick-kit)

![Estee Lauder](//images.ctfassets.net/zw35sfestf1t/57edb1Yk9fuoY0K6jj6FuT/62dbf800b527d325b9554639bc54bfb8/Estee_Lauder.jpg)
__Estée Lauder Limited-Edition Advanced Night Repair__
In honor of the Estée Lauder Companies’ Breast Cancer Campaign, the brand’s iconic smoothing and firming serum gets a pretty-in-pink update. 20 percent of the retail price benefits the Breast Cancer Research Foundation. $100, [saks.com](https://www.saksfifthavenue.com/estee-lauder-limited-edition-advance-night-repair-serum/product/0400011610707)

![Bonqs](//images.ctfassets.net/zw35sfestf1t/2DUkLXme19S1AtncUaCxtf/dcff4b7d085322947d7eecc46f6b4499/Bonqs.jpg)
__The Bouqs Co. Hope Bouquet__
The online florist has partnered with the Pink Agenda to donate 20 percent of the proceeds from its Breast Cancer Awareness Collection (*including the rose bouquet above*) to the organization. from $39, [bouqs.com](https://bouqs.com/) 

![GLAMGLOW](//images.ctfassets.net/zw35sfestf1t/1qzFUimSUGaDU5PFNUhxuU/d391ae989a0c80f2350a67013190dd10/GLAMGLOW.jpg)
__GLAMGLOW Limited-Edition GLOWLACE Radiance-Boosting Hydration Sheet Mask__
Mask for the cause with this hydrating and energizing sheet. Infused with caffeine and green tea, 20 percent of the purchase price of each mask benefits the Breast Cancer Research Foundation. $10, [sephora.com](https://www.sephora.com/product/glowlace-radiance-boosting-hydration-sheet-mask-P442553)

![HHH](//images.ctfassets.net/zw35sfestf1t/6CPUMUmwj4enD7rF1KlxbV/870d672b4d457ebdda73a379f99b4881/HHH.jpg)
__Hill House Home Sisi Silk Pillowcase__ 
Since July, Hill House Home has donated $20 from each sale of its pink 22mm mulberry silk pillowcase to The Pink Agenda in honor of breast cancer research. from $85, [hillhousehome.com](https://www.hillhousehome.com/collections/silk/products/silk-pillowcase)

![GHD](//images.ctfassets.net/zw35sfestf1t/5hCqmBOQZZCgOaUfuzeDLi/e0a36f74320b704df1a3011d575d87bf/GHD.jpg)
__ghd Platinum+ Ink On Pink Styler__ 
The hair tool brand partnered with tattoo artist David Allen to create the limited edition Ink On Pink collection. Allen, who is known for transforming mastectomy scars into art, created an original design for the multi-purpose wand and $10 from each purchase benefits Living Beyond Breast Cancer — an organization that provides post-treatment resources to breast cancer survivors. $249, [ghdhair.com](https://www.ghdhair.com/us/limited-edition-ghds/platinum-plus-ink-on-pink-styler) 

![Bobbi Brown](//images.ctfassets.net/zw35sfestf1t/gJ2fLnYWU0cNEMpSH7PMM/70a98648865a18ffecae088a55146974/Bobbi_Brown.jpg)
__Bobbi Brown Proud to Be Pink Lip Color Duo__
Featuring two of the brand’s best selling lipstick shades, Pink and Tulle, a portion ($24) from each purchase of this darling duo benefits the Breast Cancer Research Foundation. $45, [neimanmarcus.com](https://www.neimanmarcus.com/p/bobbi-brown-limited-edition-proud-to-be-pink-lip-color-duo-prod225430130)

![StFrank](//images.ctfassets.net/zw35sfestf1t/4SH1gGwYrhn9TVDzTxO3wx/61aed0b4e89e188110dd3bbdf88fdeb2/StFrank.jpg)
__St Frank Breast Cancer Awareness Embroidered Baby Alpaca Throw__ 
Cozy on up with this ethically sourced baby alpaca BCA blanket that donates 20 percent of the proceeds to Partners in Health in support of breast cancer treatment for women around the globe. $350, [stfrank.com](https://stfrank.com/collections/throw-blankets/products/breasts-embroidered-baby-alpaca-throw-blanket?variant=16059033780290)

![Aerin](//images.ctfassets.net/zw35sfestf1t/1CzCJmNjdhfUPnykRAE3Hs/097c87268ac63c165ea6984d2f8d4720/Aerin.jpg)
__AERIN Rose Lip Conditioner & Amber Musk Rollerball Set__
This travel-friendly two-for-one kit includes the musky floral scent and nourishing rose-scented lip balm with 100 percent of the purchase price donated to the Breast Cancer Research Foundation. $50, [bloomingdales.com](https://www.bloomingdales.com/shop/product/aerin-rose-lip-conditioner-amber-musk-rollerball-set?ID=3471820)

![Better Skin Co](//images.ctfassets.net/zw35sfestf1t/2emynelZecmJZin9jiygUI/a1ff87814a42d806fae00f56d17d96e2/Better_Skin_Co.jpg)
__The Better Skin Co. Better Skin Super Shield Serum__ 
For the month of October, the brand is donating 100 percent of the proceeds from the pollution-fighting serum to iGoPink. $38, [thebetterskinco.com](https://thebetterskinco.com/products/pre-order-better-skin-super-shield-ships-2-1)

![Rodin](//images.ctfassets.net/zw35sfestf1t/6BDysdFWkRuZNreECy8BGG/00ae4f2de9babb3b326e8574de6689f8/Rodin.jpg)
__RODIN olio lusso Luxury Lip Balm__
100 percent of the purchase price of this pink ribbon-adorned edition of the brand’s beloved jasmine and neroli-infused lip conditioner benefits the Breast Cancer Research Foundation. $36, [rodinoliolusso.com](https://www.rodinoliolusso.com/product/19152/71029/products/pink-lip-balm) 

![Gorjana](//images.ctfassets.net/zw35sfestf1t/3LmHFQb6YoSgCmQ9GPsjvo/2cfee7b1dfbd9a341a0a69044671fd94/Gorjana.jpg)
__Gorjana Power Gemstone Rhodochrosite Bracelet__
Rhodochrosite is known for its compassionate and supportive energy that promotes self-confidence, love, and inner joy, and, during the month of October, Gorjana is donating 50 percent of the proceeds of the bracelet to the Breast Cancer Research Foundation. $38, [gorjana.com](https://gorjana.com/products/power-gemstone-rhodocrosite-bracelet) 

![BeautyBlender](//images.ctfassets.net/zw35sfestf1t/3F0FvKlmzzJGrnCT61NEVX/d71e51d8a6ff285f2f3fee7ce4c734c9/BeautyBlender.jpg)
__BCRF Beautyblender__
In honor of Breast Cancer Awareness Month, the brand has released this bubblegum pink sponge (which is housed in a sparkling glitter canister) and is donating $20,000 to the Breast Cancer Research Foundation. $20, [ulta.com](https://www.ulta.com/bcrf-beautyblender?productId=pimprod2009762)

![JuneJacobs](//images.ctfassets.net/zw35sfestf1t/5MHiXMm9VJ9vkaCXblvZFt/5b92508a82a7582693c4fd003bec7711/JuneJacobs.jpg)
__June Jacobs Rapid Repair Healing Cream__
Clinically proven to provide 24 hours of hydration benefits, 50 percent of the net proceeds from the all-over soothing and moisturizing cream benefit the Anne Moore Breast Cancer Research Fund and the Dubin Breast Center. $60, [junejacobs.com](https://www.junejacobs.com/rapid-repair-healing-cream/321110.html) 

![VENUS](//images.ctfassets.net/zw35sfestf1t/1vfZAPOp6BJ90gZrGGGwrH/00a13a229b2a190b5149a0c1fc6da8da/VENUS.jpg)
__Venus Et Rose Eternity Roses__
The brand's (real!) roses last for a year without any water changes or wilted petals, and, throughout October, 20 percent of the sales of all Pink Rose and Pink Suede arrangements are donated to City of Hope. Starting at $44, [venusetfleur.com](https://www.venusetfleur.com/) 

![LaMer](//images.ctfassets.net/zw35sfestf1t/5D9URHWQXpGQjmOIEo7rse/dce3abfce572dda7ba43afa49be09691/LaMer.jpg)
__La Mer The Treatment Lotion__
Give your travel skincare kit an upgrade with this TSA-friendly edition of the ultra-hydrating elixir. The brand is donating 20 percent of the purchase price to the Breast Cancer Research Foundation. $110, [nordstrom.com](https://shop.nordstrom.com/s/la-mer-breast-cancer-awareness-travel-size-the-treatment-lotion-limited-edition/5360050)

![BECCA](//images.ctfassets.net/zw35sfestf1t/37BlfXUnfCR1sEfgFpqffb/3a44244352ff8e895237c9f49e75ed0d/BECCA.jpg)
__BECCA Ultimate Lipstick Love Pink Ribbon__
Enjoy eight hours of wear time *and* the nourishing benefits of avocado and olive oils with this satin-finish lippy that donates 20 percent of its purchase price to the Breast Cancer Research Foundation. $24, [beccacosmetics.com](https://m.beccacosmetics.com/product/22208/69931/lips/ultimate-lipstick-love-breast-cancer-awareness/breast-cancer-awareness-high-impact-lip-colour#!/shade/Pink_Ribbon)

![LillyPullitzer](//images.ctfassets.net/zw35sfestf1t/4vN5udsp5sxUf0jMPjAZhk/ca3a5de83544f112ff61b3fab36ad720/LillyPullitzer.jpg)
__Lilly Pulitzer Pinking Positive Hat__ 
The purveyor of preppy prints has teamed up with the Breast Cancer Research Foundation (BCRF) on a hand-painted pink design that is inspired by sisterhood and friendship. The brand is donating $22,000 to BCRF in support of the Print with Purpose collection, which includes the chic UV-blocking baseball cap. $38, [lillypulitzer.com](https://www.lillypulitzer.com/run-around-hat/000370.html?cgid=pinking-positive&dwvar_000370_color=6531NX&dwvar_000370_size=1%20SZ#start=1)

![Bumble Bumble](//images.ctfassets.net/zw35sfestf1t/4RXxgTFHk96ZFoSSuSm7SD/c2e430407ff960f5b1bbaf56bb8f76fa/Bumble___Bumble.jpg)
__Bumble and bumble Bb. Thickening Spray__
The closest you’ll get to a salon-worthy blowout at home, this lifting and volumizing mist comes dressed up in limited edition pink packaging with 20 percent of the retail price benefiting the Breast Cancer Research Foundation. $30, [bumbleandbumble.com](https://m.bumbleandbumble.com/product/19055/53187/style/pre-stylers/pink-ribbon-thickening-spray)

![BELLI](//images.ctfassets.net/zw35sfestf1t/3bczkyQOfJGRP7tm1hGXEn/d959b92634a429008a00bbfc6007f899/BELLI.jpg)
__Belli Pure Radiance Sunscreen SPF 30__ 
The brand is donating 25 percent of the proceeds from its moisturizing, mineral-based formula to iGoPink. $24, [belliskincare.com](https://www.belliskincare.com/pure-radiance-sunscreen/)

![MANTRA](//images.ctfassets.net/zw35sfestf1t/784ExpntVnmPBUa9I9Y2gy/017360dbf4e3b779ac1d6c83bb78dfc2/MANTRA.jpg)
__MantraBand Stay Strong CharityBand__
Available in rose gold, yellow gold, and silver, $5 from the purchase of the motivational cuff is donated to the Breast Cancer Research Foundation. $35, [mantraband.com](https://www.mantraband.com/products/stay-strong-charity?variant=3975960526861) 

![AVEDA](//images.ctfassets.net/zw35sfestf1t/DWz6gVzv6rFyI5JufJVmk/8fa319c61d059dd895af07f69787b1df/AVEDA.jpg)
__Aveda Hand Relief Moisturizing Creme__ 
This rich (but not greasy!) hand cream is a cult-favorite for a reason, and $5 from the purchase price of this pink tube is donated to the Breast Cancer Research Foundation. $26.50, [aveda.com](https://www.aveda.com/product/17759/70831/body/hand-care/limited-edition-hand-relief-moisturizing-creme-with-cherry-almond-aroma#/shade/5_fl_oz%2F150_ml)

![PERUVIANCONNECTION](//images.ctfassets.net/zw35sfestf1t/dTusYbfWmlTPgBvIZPkGh/e6eeb8f6baa495e5fd1912a1bcbf2776/PERUVIANCONNECTION.jpg)
__Peruvian Connection Women's Alpaca Socks to Benefit ACS__
Created in partnership with the American Cancer Society just in time for fall and winter’s cooler temps, 20 percent of the purchase price of these pink-tipped socks benefit the organization. $24, [peruvianconneciton.com](https://www.peruvianconnection.com/product/womens+alpaca+socks+to+benefit+acs.do?sortby=ourPicks&refType=&from=Search) 

![JANEIREDALE](//images.ctfassets.net/zw35sfestf1t/TR31wUWbltSWeDxD86Lj3/4c2fcd74ddc0ac46517fd7e468a3b18a/JANEIREDALE.jpg)
__Jane Iredale Forever Pink Just Kissed Lip and Cheek Stain__ 
This natural multitasker flatters any skin tone thanks to its pH-balancing pigments. 100 percent of the profits from the sale benefits Look Good Feel Better. $28, [janeiredale.com](https://janeiredale.com/us/en/mineral-makeup/lips/limited-edition-just-kissed-lip-and-cheek-stain.htm#17705-1)

![Darphin](//images.ctfassets.net/zw35sfestf1t/3B76YU2doFH4mtZJTvxos1/cacd292844f098696fd58143db658bb4/Darphin.jpg)
__Darphin INTRAL Redness Relief Soothing Serum__
The brand’s best selling soothing serum is all decked out in pink ribbon-adorned packaging for Breast Cancer Awareness Month, and 20 percent of the purchase price benefits the Breast Cancer Research Foundation. $90, [darphin.com](https://www.darphin.com/product/8502/21417/skincare/category/serums/intral-redness-relief-soothing-serum/for-a-soothed-complexion-50-ml-value-size-available)

![DONNAKAREN](//images.ctfassets.net/zw35sfestf1t/3WMXnelrESgB4jBRUPHj6d/ca37b24a56dfc78774104daa68b8e51f/DONNAKAREN.jpg)
__Donna Karan Cashmere Mist Eau de Parfum__
All dressed up in limited-edition Pink Ribbon packaging, 20 percent of the purchase price of the fragrance is donated to the Breast Cancer Research Foundation. $120, [macys.com](https://www.macys.com/shop/product/donna-karan-cashmere-mist-breast-cancer-awareness-limited-edition-eau-de-parfum-3.4-oz.?ID=9945220&CategoryID=30087&isDlp=true&isDlp=true#fn=PRODUCT_DEPARTMENT%3DFragrance%26sp%3D1%26spc%3D100%26ruleId%3D78%26kws%3Ddonna%20karan%26searchPass%3DexactMultiMatch%26slotId%3D20)

![CLINIQUE](//images.ctfassets.net/zw35sfestf1t/7tIprmTwpB61Z06DgnYBve/00faa3310c4ad69d32a6c06b8f8d931f/CLINIQUE.jpg)
__Clinique Dramatically Different Moisturizing Lotion+__
This limited edition version of the brand’s iconic moisturizer — which comes complete with a pink ribbon-inspired keyring — donates $10 from the purchase price to the Breast Cancer Research Foundation. $39, [clinique.com](https://www.clinique.com/product/7502/68808/bca/limited-edition-dramatically-differenttm-moisturizing-lotion-200ml-with-keychainin)

![Show Me Your Mumu](//images.ctfassets.net/zw35sfestf1t/2sdb1FgqiWHsZG74ql9DGF/a4510421f5dddce62a83bebb61ab97f2/Show_Me_Your_Mumu.png)
__Show Me Your Mumu Georgia Bandana__	
Use this flowery scarf as a headband, bag charm, or bandana — 100 percent of the proceeds benefit B4BC, a non-profit that supports early detection and prevention. $26, [showmeyourmumu.com](https://www.showmeyourmumu.com/shop/mumu-accessories/sarongs-scarves/georgia-bandana-heart-eyes) 

![BabyFeet](//images.ctfassets.net/zw35sfestf1t/3lYGHDi9tF1UedWpxx9qlM/6ffcd18d59081cdf316ec79b78a8ffa1/BabyFeet.jpg)
__Baby Foot Pink Ribbon Box Foot Peel__
All month long, the OG foot exfoliator is donating 20 percent of the proceeds of its lavender-scented Pink Ribbon Box to the American Cancer Society. $25, [babyfoot.com](https://www.babyfoot.com/store/Limited-Edition-Baby-Foot-1-Hour-Treatment.html) 

AEDITION complexion perfection-min

Beauty Collection | The AEDITION

Beauty

From makeup and skincare to jewelry and even fresh flowers, these products allow you to look good while doing good this October for Breast Cancer Awareness Month.

Beauty And Fashion Products That Give Back For Breast Cancer Awareness Month 2019

29 Products Giving Back For Breast Cancer Awareness Month 

victoria-strukovskaya-fu3UqXTbGcs-unsplash (1)

*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and [roundups of products that give back](https://aedit.com/aedition/beauty-fashion-products-that-give-back-for-breast-cancer-awareness-month-2019).*

According to the [U.S. Department of Health and Human Services’ National Cancer Institute](https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#r1), 268,600 women will be diagnosed with breast cancer in 2019. There will also be an estimated 2,670 new cases of invasive breast cancer reported in men. When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role, but the surgery is deeply personal and emotional. Approaching the procedure and all the decisions that accompany it armed with the best information is key, and The AEDITION here to help.

## **What Is a Mastectomy?**
A mastectomy is a surgery to remove tissue from one or both breasts in an effort to eliminate cancer cells or prevent cancerous tumors from forming in the future. Not to be confused with a lumpectomy, which extracts lumps of cancerous cells from the breast without removing all of the surrounding tissue, a mastectomy involves the removal of all the breast tissue. While a lumpectomy is a less invasive breast cancer treatment option — both physically and emotionally — it is not always an aggressive enough solution. 

## **What Are the Types of Mastectomies?**
There are four main types of mastectomies that, whether the procedure is being used for breast cancer prevention or treatment, can be performed unilaterally (removing one breast) or bilaterally (removing both breasts). Which technique is chosen often depends on a patient’s body and diagnosis. 

- **Simple (a.k.a. Total) Mastectomy**: A surgeon removes the entire breast (including the skin, tissue, nipple, and areola) but does not perform a lymph node dissection.

- **Radical Mastectomy**: Reserved for rare cases when the cancer has spread into the underlying muscles, the procedure removes the breast, three levels of underarm lymph nodes, and the chest muscles under the breast. In a more common modified radical mastectomy, the breast tissue and lymph nodes are removed but the muscles of the chest wall remain.

- **Skin-Sparing Mastectomy**: For patients who wish to combine a mastectomy with breast reconstruction surgery, this technique seeks to preserve as much of the breast skin as possible — regardless of whether a simple or radical procedure was performed.  

- **Nipple-Sparing Mastectomy**: Surgeons remove the breast tissue but keep the skin, nipple, and areola to aid the reconstruction process.

## **Do Women Carrying the BRCA1 or BRCA2 Gene Need a Prophylactic (i.e. Preventative) Mastectomy?**

About 12 percent of women in the general population will develop breast cancer in their lifetime. Of women carrying BRCA1 or BRCA2 mutations, an estimated 72 and 69 percent will develop breast cancer by the age of 80, respectively. 

While the decision is a personal one, [National Cancer Institute data shows](https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet) that women with either gene who undergo a prophylactic (a.k.a. preventative) mastectomy reduce their risk of breast cancer by 95 percent. Women who have a strong family history of breast cancer, meanwhile, see their risk mitigated by up to 90 percent with the procedure.

## **Mastectomy FAQ**
Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), who specializes in reconstructive surgery following trauma and cancer, answers some of the most common questions that accompany mastectomy procedures.

**The AEDITION**: *Is a mastectomy a 100 percent guarantee to be breast cancer-free?*

**Dr. Unger**: No, there is always a chance of recurrence. No surgery can guarantee removal of every single cell of breast tissue. Recurrence rates are usually between one and five percent, depending on multiple factors for each individual person.

**The AEDITION**: *Can men get breast cancer and need a mastectomy?*

**Dr. Unger**: Yes, men can absolutely get a mastectomy. Depending on the size of the man’s breast, the scar pattern will vary, but the goal is to create a flat chest with aesthetically acceptable scar patterns that are hopefully hidden in the creases of the male pectoral muscles, if it all possible.

**The AEDITION**: *When would someone get a unilateral versus bilateral mastectomy?*

**Dr. Unger**: There are times where bilateral mastectomy is indicated from the cancer standpoint — such as if you have cancer in both breasts or have a particular type of cancer that leads to a very high risk of having cancer in the opposite breast as well as one that is primarily diagnosed.

I typically have a long conversation with patients talking about the pros and cons of unilateral versus a bilateral mastectomy. One of the common reasons for bilateral mastectomy is many women do not feel comfortable keeping one natural breast. In these cases, there is also the additional upside of being able to attain symmetry much more easily due to the fact that I, as the reconstructive surgeon, am able to create the same thing on both sides. This is more difficult to do with one natural breast and one reconstructed breast.

Young women with a higher lifetime risk or women with large and low ptotic breasts are often best suited for bilateral, from both the risk standpoint and to create better shape and more symmetric breasts.

**The AEDITION**: *How does a patient choose between a skin-sparing and nipple-sparing mastectomy?*

**Dr. Unger**: The data is fairly clear that, unless there is direct nipple involvement, it is equally safe to get a nipple-sparing mastectomy or skin-sparing mastectomy. The reasons to get a skin-sparing mastectomy and remove the nipple are, again, if there is direct involvement of the nipple with cancer thus being unable to keep it; or if the nipple is in a very poor position — such as too low — making it an impediment for creating an aesthetically pleasing outcome. Smaller breasts and even some larger, well-shaped breasts are often good candidates for nipple-sparing mastectomy.

## **What Is It Like to Get a Mastectomy?**
The mastectomy experience varies between patients since each person has a unique medical history and diagnosis. After finding the right surgeon(s) and determining the best course of action for your condition (some mastectomies may be combined with radiation or other treatments), the mastectomy procedure generally involves the same course of action.

Without breast reconstruction, a mastectomy is usually an outpatient procedure that lasts one to three hours and is performed under general anesthesia. The surgeon typically begins by making an elliptical incision around the breast (more incisions may be needed for a nipple-sparing surgery) and removing the tissue and any other part of the breast (i.e. the nipple, skin, areola) decided upon. The sentinel node or axillary lymph node dissection will also be performed as needed.

If a reconstructive procedure is not being performed in tandem, the surgeon will insert surgical drains to accommodate excess fluid and close the incision (the drains will be removed during the first post-op appointment, about one to two weeks after the procedure). The entire surgical site is then wrapped with a bandage. 

Mastectomy side effects are similar to those of most surgeries, and many doctors will prescribe pain medication to deal with the symptoms. Most patients experience pain and swelling, buildup of blood at the surgery site, limited mobility, and numbness. Infection is also possible, as is lymphedema (fluid build-up), in cases where the nodes are removed. 

Depending on the type of mastectomy performed, some patients may be able to go home the same day, while longer hospital stays (up to three days) may be needed for bilateral and reconstructive procedures. 

## **Post-Mastectomy FAQ**
So, what can patients expect in the aftermath of a mastectomy? The AEDITION spoke to [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578), a Beverly Hills-based board certified plastic and reconstructive surgeon who is a pioneer in advanced breast reconstruction, about what to expect post-op.  

**The AEDITION**: *What does the chest look like after a mastectomy?* 

**Dr. Rogers**: How a chest looks after a mastectomy is completely dependent on the oncological breast surgeon. Different surgeons have different preferred techniques. If a traditional mastectomy is performed without a skin-sparing technique, the chest has a transverse scar on it running from the axillary lymph nodes (armpit area) to almost the sternum. If skin-sparing is performed and a tissue expander or implant is placed at the time of mastectomy, the breast can look relatively normal immediately. Additional surgeries are often needed to fine-tune the result for symmetry and optimal cosmesis.

**The AEDITION**: *When it comes to breast reconstruction after a mastectomy, what can patients expect?*

**Dr. Rogers**: There are a great many things that can be done for breast reconstruction. Many of the old limitations for reconstruction — especially after radiation therapy — no longer apply. I can build a breast using an implant or a patient’s own tissue. If a patient elects to use her own tissue, there are many different procedures to choose from. I feel the best three, in terms of the cosmetic outcome of the breast and minimal donor site morbidity, are the DIEP flap (deep inferior epigastric perforator, which runs through the abdomen), the TUG flap (transverse upper gracilis in the upper thighs), and autologous fat grafting. All of these techniques can be used to create one or both breasts without the use of an implant. 

Implant reconstructions have also gotten much better with the addition of autologous fat grafting. Fat grafting can smooth out the contours and make almost any implant reconstruction look like a natural breast. Nipples can also be reconstructed using one of a number of techniques and can look 90 percent like the original. Nipple reconstruction has been less often required in recent times due to the acceptance of nipple-sparing mastectomies.

**The AEDITION**: *When do you recommend patients get reconstructive surgery?* 

**Dr. Rogers**: I always recommend starting the reconstructive process at the time of mastectomy. The cosmetic outcomes are far superior. I also recommend skin-sparing and, if possible, nipple-sparing mastectomies. I find that even if a flap procedure is the chosen method of reconstruction, the primary placement of a tissue expander improves the cosmetic outcome and decreases complication significantly.

## **The Takeaway**
While a mastectomy is never an easy procedure for the patient or their loved ones, much progress has been made in surgical and reconstruction methods. Finding the right surgeons and treatment for your diagnosis will ensure you get the best care possible, and, for those who choose to undergo a reconstructive procedure in tandem (or in the future), natural breasts are attainable through [implants](https://aedit.com/procedure/breast-augmentation-with-implants), [fat grafting](https://aedit.com/procedure/breast-augmentation-with-fat-transfer), or a combination of the two. 

When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role, but the surgery is often deeply personal and emotional. Here, The AEDITION speaks with two preeminent reconstructive surgeons about the procedure. 

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