Archives: Cancer Types

Yes. Risk-reducing (also called preventive or prophylactic) surgery can lower the risk of breast cancer in people who are at very high risk, such as women who carry a harmful mutation in a breast cancer susceptibility gene such as BRCA1, BRCA2, TP53, or PTEN. 

The main type of surgery to reduce breast cancer risk is the removal of both breasts, called bilateral risk-reducing mastectomy (or bilateral prophylactic mastectomy). The surgery may be a total mastectomy, in which the nipple and areola are removed, or a nipple-sparing mastectomy, which preserves the nipple and areola. Total mastectomy provides slightly more risk reduction, whereas nipple-sparing mastectomy allows for more natural-looking breasts after breast reconstruction surgery (1).  

A second type of risk-reducing surgery is the removal of both ovaries (bilateral prophylactic oophorectomy) or of the ovaries and the fallopian tubes (bilateral prophylactic salpingo-oophorectomy, also called risk-reducing salpingo-oophorectomy). This surgery is often used to reduce the risk of ovarian and fallopian tube cancer in those who are at high risk for the disease because of inherited harmful changes in BRCA1, BRCA2, and several other genes. Some studies have suggested that risk-reducing salpingo-oophorectomy also reduces the risk of breast cancer in women at high risk, but other studies have not shown such a reduction (2–5).

Bilateral mastectomy has been shown to reduce the risk of breast cancer by at least 95% in women who have a harmful (disease-causing) variant in the BRCA1 gene or the BRCA2 gene and up to 90% in women who have a strong family history of breast cancer (6–9). (It is important to keep in mind that mastectomy is not 100% effective at reducing risk because it is impossible to remove all the breast tissue that may be at risk of becoming cancerous in the future.)

People who are known to have inherited a harmful mutation that greatly increases their risk of developing breast cancer may consider having bilateral risk-reducing mastectomy to reduce this risk. 

People who have a high risk of breast cancer but are not known to have inherited a harmful mutation may want to discuss with their doctors the possible benefits and harms of risk-reducing mastectomy in their situation. Such people include those with pleomorphic lobular carcinoma in situ (PLCIS) plus a strong family history of breast cancer and those who have had radiation therapy to the chest (including the breasts) before age 30 years.

Yes. Some people who have been diagnosed with cancer in one breast, particularly those who are known to be at very high risk, may consider having the other breast (called the contralateral breast) removed as well, even if there is no sign of cancer in that breast. Removal of the contralateral breast during breast cancer surgery (known as contralateral prophylactic mastectomy) reduces the risk of breast cancer in that breast (1,6,8,9). 

However, doctors often discourage contralateral prophylactic mastectomy for people with cancer in one breast who do not have a high risk of developing a contralateral breast cancer. That is because their risk of developing another breast cancer, either in the same or the other breast, is very small (10), especially if their treatment included adjuvant chemotherapy or hormone therapy (11,12). Contralateral mastectomy may also increase the risk of complications and could result in delays in treatment for the known cancer. Moreover, the evidence to date does not indicate that contralateral prophylactic mastectomy reduces mortality.  

People with a harmful BRCA variant who have surgery to treat breast cancer may also consider having risk-reducing salpingo-oophorectomy to improve their long-term outcomes. The risk of dying from any cause after breast cancer surgery for patients with a BRCA variant was reduced by more than half if they also received prophylactic salpingo-oophorectomy (13). The risk reduction was greater for those with a harmful variant in BRCA1 than for those with a harmful variant in BRCA2.

As with any other major surgery, bilateral prophylactic mastectomy and bilateral prophylactic salpingo-oophorectomy have potential complications or harms, such as bleeding or infection (14). Also, both surgeries are irreversible. 

Breast removal can also affect psychological well-being due to a change in body image and the loss of normal breast functions. Although most people who choose to have this surgery are satisfied with their decision, they can still experience anxiety and concerns about body image (15,16). People who undergo total mastectomies lose nipple sensation, which may hinder sexual arousal.

The sudden drop in estrogen production caused by bilateral prophylactic salpingo-oophorectomy induces early menopause (this is also called surgical menopause). The abrupt onset of menopausal symptoms, including hot flashes, insomnia, anxiety, and depression, can be distressing. 

People who have severe menopausal symptoms after undergoing bilateral prophylactic salpingo-oophorectomy may consider using short-term menopausal hormone therapy after surgery to alleviate these symptoms. Learn more about the health effects of menopausal hormone therapy.

Options for some people who are at very high risk of breast cancer (or of contralateral breast cancer, if they have previously been treated for breast cancer) and wish to avoid risk-reducing surgery include:

• More frequent breast cancer screening (also called enhanced surveillance). For example, they may have yearly mammograms and yearly magnetic resonance imaging (MRI) screening—with these tests staggered so that the breasts are imaged every 6 months—as well as clinical breast examinations performed regularly by a health care professional (17).
• Risk-reducing medications (sometimes called chemoprevention). Tamoxifen and raloxifene are approved by the U.S. Food and Drug Administration (FDA) to reduce breast cancer risk in women who, based on their personal and family medical history, have an increased risk of breast cancer. Whether these medications can be used to prevent breast cancer in women with inherited harmful mutations in BRCA1, BRCA2, or other genes associated with breast cancer risk is not yet clear (18). However, tamoxifen may lower the risk of contralateral breast cancer among BRCA1 and BRCA2 variant carriers previously diagnosed with breast cancer (19).

Risk-reducing salpingo-oophorectomy greatly reduces the risk of ovarian cancer and is the most effective approach. However, it has serious side effects, such as inducing early menopause in premenopausal women. Since many ovarian cancers are thought to start in the fallopian tubes, researchers are investigating the use of just salpingectomy to see if this also reduces the risk of ovarian cancer while sparing women from early menopause. However, this is not yet an option in clinical practice.

Another potential option is the use of oral contraceptives. Studies have consistently shown that women who have ever used oral contraceptives have a 30% to 50% lower risk of ovarian cancer than women who have never used oral contraceptives (20–22). A reduction in ovarian cancer risk with use of oral contraceptives has been seen not just among women in general but also among women who carry a harmful variant in the BRCA1 or BRCA2 gene (23–25).

These hormone-containing medications are thought to reduce the risk of ovarian cancer by preventing ovulation, which reduces exposure to naturally occurring female hormones that fuel the growth of ovarian cancer cells.

Many health insurance companies have official policies about whether and under what conditions they will pay for risk-reducing surgeries for breast and ovarian cancer risk reduction. However, the criteria used for considering these procedures as medically necessary may vary among insurance companies. Some insurance companies may require a second opinion or a letter of medical necessity from the health care provider before they will approve coverage of any surgical procedure. A person who is considering risk-reducing surgery should discuss insurance coverage issues with their doctor and insurance company before choosing to have the surgery.

If someone has a strong family history of breast cancer, ovarian cancer, or both, they and other members of their family should talk with a genetic counselor to understand whether they are truly at very high risk (that is, are likely to have a harmful variant in BRCA1, BRCA2, or another gene linked to breast cancer). A genetic counselor or other health care provider trained in genetics can review the family’s risks of disease and help family members obtain genetic testing for harmful changes in cancer-predisposing genes, if appropriate.

The decision to have any surgery to reduce the risk of breast cancer is a major one. Someone who is at high risk of breast cancer may wish to get a second opinion on risk-reducing surgery as well as on alternatives to surgery. For more information on getting a second opinion, see NCI’s Finding Health Care Services page.

A person who is considering risk-reducing mastectomy may also want to talk with a breast surgeon and a surgeon who specializes in breast reconstruction. Other health care professionals, including a breast health specialist, medical social worker, or cancer clinical psychologist or psychiatrist, can also help someone consider their options for reducing their risk of breast cancer.

Mammograms are x-ray images of the breasts. Mammograms are used for breast cancer screening because they can find tumors at an earlier stage, before they cause symptoms.

Mammograms can also be used to check for breast cancer after a woman or her doctor finds a lump or other change. This type of mammogram is called a diagnostic mammogram.

The same machines are used for both types of mammograms. However, diagnostic mammography requires images from more angles than screening mammography, so the dose of radiation is higher.

Mammograms can show a mass (breast lump), deposits of calcium (called calcifications), and other changes. They also show breast density. A radiologist will study the mammogram for unusual changes. When possible, the radiologist will compare your most recent mammogram with past mammograms to check for changes in breast tissue since your last mammogram.

Dense Breasts: Answers to Commonly Asked Questions

Learn what breast density is and how it can affect a woman’s risk for breast cancer.

Mass (also called a breast lump): The size, shape, and edges of a lump give the radiologist important information. A lump that is not cancer often looks smooth and round and has clear, defined edges. Lumps that look like this are often benign cysts. However, if the lump has a jagged outline, an irregular shape, or other unusual features, more tests may be needed.

Calcifications are deposits of calcium in the breast that are too small to be felt. There are two types, neither of which is related to calcium in your diet:

• Macrocalcifications look like small white dots on a mammogram. They are often caused by aging, an old injury, or inflammation and are usually benign.
• Microcalcifications look like white specks on a mammogram. If found in an area of rapidly dividing cells or grouped together in a certain way, they may be a sign of DCIS or breast cancer.

Breast density describes the relative amounts of dense and fatty tissue in the breasts, as seen on a mammogram. Mammography is more likely to miss cancer in women with dense breasts.

During a mammogram, your breast is placed between two plates that are then pressed together. Pressing the breast helps get a better x-ray picture of the inside of your breast. Several images are taken from different angles, with the breast repositioned each time.

For some people, the compression of the breast can be painful. Taking an over-the-counter pain medication before the procedure may lessen the discomfort.

If possible, try not to schedule your mammogram right before or during your menstrual period, when your breasts may be especially tender.

You should avoid using personal care products, such as deodorants, antiperspirants, powders, lotions, creams, or perfumes, around the breasts or under the arms on the day of your mammogram.

You will receive the radiologist’s report of your screening mammogram within about 2 weeks, either by mail or in your electronic medical record. The results will also be sent to the health care provider who ordered the mammogram. If you don’t get your results within 2 weeks, you should contact your provider.

The report of your screening mammogram will usually include the BI-RADS category. BI-RADS categories provide a consistent way for radiologists to report a range of possible mammographic findings, with the recommended follow-up.

Breast Imaging Reporting and Database System (BI-RADS)

The mammogram screening report also includes information on breast density.

Depending on your result, you may be called back for further imaging or a biopsy. The letter with your results will explain what follow-up exams you may need. 

Although it can be scary to be called back for further testing, it is important to keep in mind that most people who are called back are not found to have breast cancer. 

The U.S. Preventive Services Task Force (USPSTF) currently recommends that women at average risk of breast cancer have screening mammograms every 2 years between ages 40 and 74. Talk with your doctor to find out your risk for breast cancer, based on your personal and family health history.

Some individuals at very high risk of breast cancer may be advised to begin screening for breast cancer at a younger age and to get screened more often than those at average risk. For example, anyone who received treatment for a childhood cancer that included radiation therapy to the breast or chest may be advised to begin screening at age 25, or 8 years after finishing radiation therapy, whichever is later. People who have known harmful mutations in the BRCA1 or BRCA2 genes may also consider having earlier or more frequent screening.

Three-dimensional, or 3D, mammography, also called digital breast tomosynthesis (DBT), creates three-dimensional images of the breast. To do this, the DBT machine takes multiple pictures of thin “slices” across the breast that are then assembled into a 3D picture by computer software. DBT also creates 2D images of the breast like those created by standard mammography.

DBT combined with standard mammography is better at finding tumors than standard mammography alone. However, it’s still unknown whether DBT is more effective than standard mammography at reducing deaths from breast cancer. The NCI-sponsored TMIST trial is comparing 2D mammography with DBT to answer this question.

Yes. Women with breast implants should continue getting mammograms. However, most women who have breast reconstruction with implants after mastectomy usually do not need a mammogram of the reconstructed breast.

Implants can hide some breast tissue, making it harder for a radiologist to see unusual changes on the mammogram. If you have breast implants you should let the mammography facility know. A special technique called implant displacement views may be used.

Mammograms are available in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices. You may be able to schedule your own screening mammogram directly with the mammography facility without a referral from your doctor.

The Mammography Quality Standards Act (MQSA) is a federal law that requires mammography facilities across the nation to meet uniform quality standards. MQSA regulations also require that mammography facilities give patients an easy-to-read report of their mammogram results.

If you need help finding an FDA-certified mammography facility near you, you can contact NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). A searchable list is available from the FDA.

Insurance plans governed by the federal Affordable Care Act must cover screening mammograms as a preventive benefit every 1–2 years for women ages 40 and over without requiring copayments, coinsurance, or deductibles. In addition, many states require that Medicaid and public employee health plans cover screening mammography. Contact your mammography facility or health insurance company to confirm the cost and coverage.

Medicare pays for annual screening mammograms for all female Medicare beneficiaries who are age 40 or older. Information about coverage of mammograms is available from Medicare.

If you need a diagnostic mammogram, check with your health insurance provider about coverage.

Some state and local health programs and employers provide mammograms free or at low cost. For example, CDC’s National Breast and Cervical Cancer Early Detection Program provides screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States and in several U.S. territories. Contact information for local programs is available from the CDC or by calling 1–800–CDC–INFO (1–800–232–4636).

Information about free or low-cost mammography screening programs is also available from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and from local hospitals, health departments, women’s centers, or other community groups.

Many women who have a mastectomy—surgery to remove an entire breast to treat or prevent breast cancer—have the option of having the shape of the removed breast rebuilt. Some people choose not to have their breasts reconstructed after a mastectomy, instead preferring a flat closure.

Breasts can be rebuilt using implants (saline or silicone) or autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.

Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy, called immediate reconstruction, or it can be done after the mastectomy incisions have healed and treatment has been completed, called delayed reconstruction. Delayed reconstruction can happen months or even years after the mastectomy.

In the final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.

Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.

Implants are inserted underneath the skin or chest muscle following the mastectomy. Implants are usually placed as part of a two-stage procedure.

• In the first stage, the surgeon places a device called a tissue expander under the skin that is left after the mastectomy or under the chest muscle (1, 2). The expander is slowly filled with saline or air during periodic visits to the doctor after surgery.
• In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after the tissue expander is placed.

In some cases, the implant can be placed in the breast during the same surgery as the mastectomy—that is, a tissue expander is not used (3).

Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or “sling” to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman’s body and used to rebuild the breast. This piece of tissue is called a flap.

Different sites in the body can provide flaps for breast reconstruction. Flaps most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.

Depending on their source, flaps can be pedicled or free.

• With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
• With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery, to give the reconstructed breast a blood supply.

Abdominal and back flaps include:

• DIEP flap: Tissue comes from the abdomen and contains only skin, blood vessels, and fat, without the underlying muscle. This type of flap is a free flap.
• Latissimus dorsi (LD) flap: Tissue comes from the middle and side of the back. This type of flap is pedicled when used for breast reconstruction. (LD flaps can also be used for other types of reconstruction, such as abdominal or head and neck reconstruction.)
• SIEA flap (also called SIEP flap): Tissue comes from the abdomen as in a DIEP flap but includes a different set of blood vessels. It also does not involve cutting of the abdominal muscle and is a free flap. This type of flap is not usually an option for breast reconstruction because the necessary blood vessels are often not adequate or do not exist.
• TRAM flap: Tissue comes from the lower abdomen as in a DIEP flap but includes muscle. TRAM flaps can be either pedicled or free.

Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who don’t have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps.

• IGAP flap: Tissue comes from the buttocks and contains only skin, blood vessels, and fat.
• PAP flap: Tissue, without muscle, comes from the upper inner thigh.
• SGAP flap: Tissue comes from the buttocks as in an IGAP flap but includes a different set of blood vessels and contains only skin, blood vessels, and fat.
• TUG flap: Tissue, including muscle, comes from the upper inner thigh.

The table below summarizes the different types of flaps used for breast reconstruction:

In some cases, an implant and autologous tissue are used together. For example, with flaps taken from the thigh or buttocks an implant is often used as well to provide sufficient breast volume. Also, autologous tissue may be used to cover an implant when there isn’t enough skin and muscle left after mastectomy to allow for expansion and use of an implant (1, 2).

After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, the nipple and areola can be reconstructed. This can be done in two ways—surgically or with tattoos. 

For surgical nipple reconstruction, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months later, the surgeon can re-create the areola. This is usually done using tattoo ink.

However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction (1).

Alternatively, a new nipple and areola can be created by a tattoo artist who specializes in 3-D nipple tattooing. Such a nipple is flat to the touch but looks realistic.

A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts (4, 5).

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.

Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the woman’s age and health, her history of past surgeries, her risk factors for complications after surgery (for example, smoking history and obesity), the availability of autologous tissue, and the location of the tumor in the breast (2, 6). Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.

Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.

Reconstruction with Implants

Surgery and recovery

• Enough skin and muscle must remain after mastectomy to cover the implant
• Shorter surgical procedure than for reconstruction with autologous tissue; little blood loss
• Recovery period may be shorter than with autologous reconstruction
• Many follow-up visits may be needed to inflate the expander and insert the implant

Possible complications

• Infection
• Accumulation of clear fluid causing a mass or lump (seroma) within the reconstructed breast (7)
• Pooling of blood (hematoma) within the reconstructed breast
• Blood clots
• Extrusion of the implant (the implant breaks through the skin)
• Implant rupture (the implant breaks open and saline or silicone leaks into the surrounding tissue)
• Formation of hard scar tissue around the implant (known as a contracture)
• Obesity, diabetes, and smoking may increase the rate of complications
• Very small risk of developing a very rare form of immune system cancer called breast implant associated–anaplastic large cell lymphoma, particularly with textured implants
• A small number of squamous cell carcinomas and various lymphomas in the scar tissue around implants have been reported, but they are very rare

Other considerations

• May not be an option for patients who have previously undergone radiation therapy to the chest
• May not be adequate for women with very large breasts
• Will not last a lifetime; the longer a woman has implants, the more likely she is to have complications and to need to have her implants removed or replaced
• Silicone implants may feel more natural than saline implants to the touch
• The Food and Drug Administration (FDA) recommends that women with silicone implants undergo periodic MRI screenings to detect possible “silent” rupture of the implants

More information about implants can be found on FDA’s Breast Implants page.

Reconstruction with Autologous Tissue

Surgery and recovery

• Longer surgical procedure than for implants
• The initial recovery period may be longer than for implants
• Pedicle flap reconstruction is usually a shorter operation than free flap reconstruction and usually requires a shorter hospitalization
• Free flap reconstruction is a highly technical operation that requires a surgeon who has experience with microsurgery to reattach blood vessels.

Possible complications

• Necrosis (death) of the transferred tissue
• The risk of bleeding and blood clots is higher with autologous reconstruction than with implants
• Pain and weakness at the site from which the donor tissue was taken
• Obesity, diabetes, and smoking may increase the rate of complications

Other considerations

• May provide a more natural breast shape than implants
• May feel softer and more natural to the touch than implants
• Leaves a scar at the site from which the donor tissue was taken
• Can be used to replace tissue that has been damaged by radiation therapy

All women who undergo mastectomy for breast cancer experience varying degrees of numbness and loss of feeling in the breast because nerves that provide sensation to the breast are cut when breast tissue is removed during surgery. However, some breast sensation may be regained as the severed nerves grow and regenerate, and breast surgeons continue to make technical advances that can spare or repair damage to nerves.

Any type of breast reconstruction can fail if healing does not occur properly. In these cases, the implant or flap will have to be removed. If an implant reconstruction fails, a woman can usually have a second reconstruction using an alternative approach.

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that requires group health plans and health insurance companies that offer mastectomy coverage to also pay for reconstructive surgery after mastectomy. This coverage must include all stages of reconstruction and surgery to achieve symmetry between the breasts, breast prostheses, and treatment of complications that result from the mastectomy, including lymphedema. More information about WHCRA is available from the Department of Labor and the Centers for Medicare & Medicaid Services.

Some health plans sponsored by religious organizations and some government health plans may be exempt from WHCRA. Also, WHCRA does not apply to Medicare or Medicaid. However, Medicare may cover breast reconstruction surgery as well as external breast prostheses (including a post-surgical bra) after a medically necessary mastectomy. Medicaid benefits vary by state; a woman should contact her state Medicaid office for information on whether, and to what extent, breast reconstruction is covered.

A woman considering breast reconstruction may want to discuss costs and health insurance coverage with her doctor and insurance company before choosing to have the surgery. Some insurance companies require a second opinion before they will agree to pay for a surgery.

Any type of reconstruction increases the number of side effects a woman may experience compared with those after a mastectomy alone. A woman’s medical team will watch her closely for complications, some of which can occur months or even years after surgery (1, 2, 8).

Women who have breast reconstruction may benefit from physical therapy to improve or maintain shoulder range of motion or help recover from weakness experienced at the site from which donor tissue was taken for an autologous reconstruction (9, 10). A physical therapist can help a woman use exercises to regain strength, adjust to new physical limitations, and figure out the safest ways to perform everyday activities.

Mammography is not typically done on a breast that is reconstructed after mastectomy; instead, physical exams are done to check for recurrence. However, women who have one breast removed by mastectomy will still have mammograms of the other breast.

A flat closure (also called aesthetic flat closure) is surgery done to rebuild the shape of the chest wall after the removal of one or both breasts. It is also a surgical option for people who have had their breast implants removed.

During an aesthetic flat closure, a surgeon removes extra skin, fat, and other tissue in the breast area. The remaining tissue is then tightened and smoothed out so that the chest wall appears flat and contoured. Simply forgoing additional procedures to reconstruct the breast(s) after a mastectomy will not achieve a flat closure (11).
 

• Oncoplastic surgery. In general, women who have lumpectomy or partial mastectomy for early-stage breast cancer do not have reconstruction. However, in some cases the surgeon may use plastic surgery techniques to reshape the breast at the time of cancer surgery. This type of breast-conserving surgery, called oncoplastic surgery, may use local tissue rearrangement, reconstruction through breast reduction surgery, or transfer of tissue flaps. Long-term outcomes of this type of surgery are comparable to those for standard breast-conserving surgery (12).
   
• Autologous fat grafting. A newer type of breast reconstruction technique involves the transfer of fat tissue from one part of the body (usually the thighs, abdomen, or buttocks) to the reconstructed breast. The fat tissue is harvested by liposuction, washed, and liquified so that it can be injected into the area of interest. Fat grafting is mainly used to correct deformities and asymmetries that may appear after breast reconstruction. It is also sometimes used to reconstruct an entire breast. Although concern has been raised about the lack of long-term outcome studies, this technique is considered safe (1, 6, 13).