Mastectomy with axillary dissection can take 2-3 hours. If reconstruction is performed at the same time, surgery will take longer…

Breast-conserving surgery (lumpectomy) removes the cancer and just enough tissue to get all the cancer. For 1 or 2 days after the surgery, you will probably feel tired and have some pain. The skin around the cut (incision) may feel firm, swollen, and tender, and be bruised…

…The pre-pectoral procedure is the most minimally invasive breast reconstruction option. Your doctor can perform a mastectomy by removing breast tissue through a small incision underneath the breast. Through this incision, a tissue expander can be placed on top of the muscle to create a breast mound…

…Double mastectomy is sometimes done as a risk-reducing (or preventive) surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation…

In this procedure, most of the skin over the breast is left place. Only the breast tissue, nipple, and areola are removed. The amount of breast tissue removed is the same as with a simple mastectomy…

…The surgeon removes the entire breast, axillary (underarm) lymph nodes, and the pectoral (chest wall) muscles under the breast. This surgery was once very common, but less extensive surgery (such as the modified radical mastectomy) has been found to be just as effective and with fewer side effects. This operation might be done if the tumor is growing into the pectoral muscles.

A modified radical mastectomy combines a simple mastectomy with the removal of the lymph nodes under the arm (called an axillary lymph node dissection).

In this procedure, the surgeon removes the entire breast, including the nipple, areola, fascia (covering) of the pectoralis major muscle (main chest muscle), and skin…

When a woman cannot be treated with breast-conserving surgery (lumpectomy), which saves most of the breast…

Having both breasts removed is recommended for women at very high risk of breast cancer. For example, those who have tested positive for a breast cancer (BRCA) gene change are at very high risk…

Clinical Prognostic Stage is used first to assign a stage for all patients based on health history, physical exam, imaging tests (if done), and biopsies… Pathological Prognostic Stage is then used for patients who have surgery as their first treatment… Anatomic Stage is based on the size and the spread of cancer as described by the TNM system…

Breast ultrasound. A machine that uses sound waves to make pictures, called, sonograms, of areas inside the breast…

…A technologist will place your breast on a plastic plate. Another plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is being taken…

…the size of your cancer, where the cancer is in your breast, whether there is more than one area of cancer, the size of your breasts, your general health…

…having a nipple tattoo, having a nipple made from your own body tissue, using a stick on nipple…

…This type of reconstruction is a simpler operation than an abdominal flap (TRAM or DIEP flaps) and so recovery may be quicker and easier. Unlike the most common type of abdominal flap, this reconstruction keeps its original blood supply…

The rectus abdominis muscle is in your abdomen and runs from your breastbone to your pubic bone. For a TRAM flap reconstruction, the surgeon takes part of this muscle, with its skin, fat, and blood vessels. They move it to your chest wall to make a new breast…

With this operation, your surgeon takes skin, fat, and sometimes muscle (a flap) from another part of your body and makes it into a breast shape…

This operation means that you have a silicone gel or salt water filled silicone balloon to recreate a breast shape after removal of a breast…

…simple arm exercises can help to: keep your movement full in your arm and shoulder, relieve pain and stiffness, reduce swelling

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips…

…Depending on the type of surgery you have, you will most likely be able to go home from the hospital within a few days. You may be discharged with one or more drains in place. A drain is a small tube that’s put in the wound to remove extra fluid from the surgery site while it heals…

… pain and numbness (peripheral neuropathy), dental issues, lymphedema…

A lightweight model (polyfill or foam) is recommended when you’re recovering from surgery, because it’s most comfortable… A silicone prosthesis may look more realistic and feel more natural to you for everyday wear…

a breast lump or thickening; alteration in size, shape or appearance of a breast; dimpling, redness, pitting or other alteration in the skin…

…regular physical activity; weight control; avoidance of harmful use of alcohol…

Breast cancer arises in the lining cells (epithelium) of the ducts (85%) or lobules (15%) in the glandular tissue of the breast. Initially, the cancerous growth is confined to the duct or lobule (“in situ”) where it generally causes no symptoms and has minimal potential for spread (metastasis)…

…Helps to evaluate the extent of disease and assists the oncologist in determining whether chemotherapy or radiation therapy is required…

Nipple-sparing mastectomy, where only the breast tissue is removed…

Surgery to remove the entire breast (mastectomy). Surgery to remove a portion of the breast tissue (lumpectomy. Surgery to remove nearby lymph nodes…

In order to see one of the plastic surgeons at UHN/Mount Sinai Hospital in Toronto, you will require a referral from a physician. The physician can download and complete the Plastics and Reconstructive Surgery referral form on our UHN website and submit via fax once complete. You will then be contacted by our administrative team regarding an appointment.

We are so sorry to hear that breast reconstruction is not offered at your local hospital. Your surgeon can provide you alternative hospitals where breast reconstruction is performed and can refer you to these centers. You will need to see both a general surgeon and plastic surgeon for mastectomy and breast reconstruction consultation. There is a list of hospitals that perform mastectomy and breast reconstruction available through Cancer Care Ontario’s website. You can also check with Cancer Care Ontario’s website to find out if any of these hospitals are near where you live, and the volume of breast cancer surgeries performed at these hospitals.

BRAVA is one example of an external negative pressure tissue expander used to expand the skin envelope in preparation for large volume fat transfer from one (or several) area(s) of the body to recreate the breast(s). This method can be used to assist with breast reconstruction in the setting of a mastectomy or lumpectomy. Currently, there are select institutions within Canada who offer these services. The fat grafting procedure is covered by OHIP if being utilized for breast reconstruction however the patient is responsible for purchasing the device.

It is definitely a common concern that the implant feels “foreign” or strange after the mastectomy and reconstruction. This is because nerves to the breast are completely cut during the mastectomy and this results in the whole breast feeling numb. However, some sensation can return since nerves can regenerate in this region. Having an immediate reconstruction has been found to help with the return of sensation to the breast. Rest assured that the “weird” sensation will gradually improve with time, and it is not unusual to take more than one year.

Breast Implants are synthetic medical devices like artificial joint or mechanical heart valves, and no medical synthetic device is meant to last a life-time. That said, breast implants do not have an expiry date. So that means there is no set date in the future when they HAVE to be replaced. Most of our studies find that around 50% of women with breast implants have breast implant revision surgery within 5 years. Most of these revisions are for cosmetic correction or to change the size of the implants. Implant problems can happen, and the most common problem that needs s revision is capsular contracture, or tight scarring around the implant.

There is no consensus on the timing of breast implant monitoring in Canada. The answer will depend on the indication for breast implantation (augmentation vs. reconstruction) and the type of implant that the patient has.
For saline implants, monitoring is probably not necessary as any malfunction of the implant will be detected by the patient right away with deflation of the implant. However, if a patient has a silicone implant, then implant leak can occur “silently”. I would advise that the patient who undergoes implant surgery have a thorough physical examination with her surgeon every year and if there are any concerns, then the surgeon will order the appropriate breast imaging.

This is an excellent question! I was tasked by Cancer Care Ontario with being the Clinical Lead of a Working Group a few years ago to develop standardized provincial guidelines for post mastectomy breast reconstruction a few years ago and we examined this very question in detail. Scientific evidence suggests that mastectomy removes over 90-95% of the breast tissue; there is no role for any imaging surveillance after mastectomy with or without reconstruction.

This is an excellent question! I was tasked by Cancer Care Ontario with being the Clinical Lead of a Working Group a few years ago to develop standardized provincial guidelines for post mastectomy breast reconstruction a few years ago and we examined this very question in detail. Scientific evidence suggests that mastectomy removes over 90-95% of the breast tissue; there is no role for any imaging surveillance after mastectomy with or without reconstruction.

Breast reconstruction can be done at the same time as mastectomy surgery (immediate reconstruction) or after mastectomy surgery (delayed reconstruction). There are pros and cons associated with having immediate vs. delayed reconstruction. However, the most important thing is that you should be told of your options for breast reconstruction before you make your decision about mastectomy so that you can begin your informed decision-making process as far in advance as possible. Think about your preferences, ask questions and remember that decision to have reconstructive surgery is about you and you only.

Yes it is absolutely fine to go flat after mastectomy and forego reconstruction. Not every woman wants to have breast reconstruction and not every woman is a candidate for breast reconstruction. If you choose to go flat, your surgeon will design a different incision on your breast and try to leave you with as smooth of a chest contour as possible without a lot of rolls or excessive skin. The chest will feel totally numb permanently. You can opt for an external prosthesis after your chest has healed from surgery, but there are some inconveniences associated with a moderate to large external breast prosthesis. If you ever decide that you wish to pursue breast reconstruction down the road, there are definitely options.

This is a great question and deserves a detailed answer. The breast reconstruction that is made up of an implant or abdominal tissue cannot develop breast cancer because it does not contain breast tissue. However, even with the best mastectomy there is always some breast tissue that is left behind. Therefore, there is a chance that the breast tissue that is left in the breast surround the reconstruction can develop a new breast cancer or recurrent breast cancer. The risk of this is generally extremely small, but will depend on the size and grade of the initial breast tumour, radiation status and of course the completeness of the mastectomy.

This is a common question that we get as reconstructive surgeons. From our perspective, it is important that you speak with your breast surgeon as well about your risk of getting breast cancer on the other breast. In a small percentage of patients, like those who have a genetic predisposition towards cancer, they are at significantly higher risk for breast cancer. We recommend that those patients have prophylactic mastectomy to reduce their risk of breast cancer. In most patients, however, removing the other breast does not actually reduce their risk of breast cancer development. In some patients, symmetry is best obtained when the same procedure is done to both sides. However, in many patients, we can also obtain excellent symmetry of the two breasts without needing to perform mastectomy and reconstruction to both sides.

Lymphatic massage is important after surgery because extra fluid can build up around the surgical site that exceeds the normal elimination of lymphatic fluid. Lymphatic drainage is important for getting rid of wastes and toxins that can build up in our body tissues. Stimulating the lymphatics after surgery will help with the toxin-reducing process and help with wound healing.

Women diagnosed with in-situ and early stage breast cancers have equal survival after lumpectomy and mastectomy with immediate breast reconstruction.
PRO FOR MASTECTOMY WITH IMMEDIATE BREAST RECONSTRUCTION: Lumpectomy is always followed by radiation. So for those who wish to avoid radiation and its side effects, mastectomy with immediate breast reconstruction may be more desirable.
PRO FOR LYUMPECTOMY: On the other hand, mastectomy will always leave the breast feeling numb, no matter how realistic the reconstructed breast appears. In patients who wish to preserve as much sensation to their breast as possible, then lumpectomy is a better option.

It is normal to feel afraid or overwhelmed when your doctor tells you that you need chemotherapy. However, you will be cared for by a team of highly trained healthcare specialists who will assist in ensuring optimal treatment. Each chemotherapy treatment plan is individualized. Prior to beginning chemotherapy treatment, you will meet with your medical oncologist to determine your exact treatment plan (e.g., schedule, number of cycles, drugs administered, method of administration, etc.). How you prepare and what you can expect during your treatment will depend on this exact treatment regimen. Your medical oncology team will give you these specific instructions and information. Examples of how you may need to prepare for chemotherapy include undergoing tests and procedures to ensure your body is ready to receive chemotherapy, a dental appointment to check for a tooth infection, make arrangements for help at home or work, and plan ahead for any short and long-term side effects (e.g., infertility, hair loss).

Radiation is highly effective at killing any residual tumour cells that may be left behind after surgery. However, it can have some deleterious effects on the normal tissue around an implant. Compared to a non-radiated breast, radiated breast will have more capsular contracture (tight and thickened scar tissue) around the breast implant. The normal tissue around the implant can undergo shrinkage. In addition, the normal pectoralis muscle in front of the implant can be tight and have less muscle excursion.

For anyone undergoing breast surgery, you can optimize your postoperative healing if you can adhere to the following instruction. The more fit and conditioned you are before surgery, the better you will generally recover after any type of surgery. I recommend using a preoperative antibiotic wash for 7 days before breast surgery, and this can reduce postoperative infection. Early manual lymphatic massage therapy and physiotherapy have also been shown to help with healing after surgery.

There are many health practices which are re-evaluated by women once receiving their cancer diagnosis. Nutrition is certainly one of these. A healthy diet is one of several factors which affect the immune system. There is no food which will fully prevent your risk of breast cancer or recurrence. However, some simple guidelines for cancer prevention include increasing intake of fruits, vegetables and whole grains; fat consumption less than 30% of total daily caloric intake; alcohol consumption in moderation; and achieving and maintaining a healthy weight.

• Ontario Health Card
• Post-mastectomy bra(s) or
camisole(s)
• Clothing – shirt that opens in the front; pants that are soft with a loose waistband
• Protective cases for eyeglasses, hearing aids and dentures
• CPAP machine, if you require one
• Slippers or shoes with non-skid
soles
• Toiletries, including toothbrush and toothpaste

NOTE: Valuables are encouraged to be left at home or have your loved one bring it to you postop should you require them

1. Take your friend’s young kids out for a day or a sleepover so that your friend can enjoy some quiet introspective time alone or with her partner
2. Send a meal for the entire family the day after she gets back from the hospital (something on the lighter side and nutritious of course)
3. Chicken soup (always heals the
body and the soul)
4. Offer to drive your friend’s young kids to school and their after school activities for the first week after she comes home from her treatment
5. Soft and pretty PJs
6. A comfortable and well-fitting post surgical bra if your friend is going to have surgery

This is true! During lactation (when your breasts produce milk), your body produces lower levels of estrogen. Prolonging periods of breastfeeding can reduce a woman’s lifetime exposure to estrogen which in turn significantly reduces the risk of breast cancer.

This has never been a study that has definitively shown a DIRECT OR CAUSAL relationship between alcohol consumption and breast cancer. However, studies have shown that more than 10 drinks per week may be associated with a higher risk of developing breast cancer. Sorry ladies, while drinking red wine may be good for your heart health, it may be negative for your breast health.