Those three things are, largely, still what women want today, though many opt for surgical replacements rather than padded bras. Breast reconstruction is a highly technical and evolving field that employs techniques and technologies from beyond the typical boundaries of surgery—from stem cells to 3D-printed nipples.
It’s hard to pin down exactly how many people get mastectomies in the United States. According to the Journal of the American Medical Association, about 35 percent of women with early-stage breast cancer will undergo mastectomies. The rate of women with a genetic predisposition for cancer getting preventive mastectomies is hard to determine too, but according to several studies and institutions, that rate is increasing.
Not everyone opts to rebuild afterward. According to one study about 42 percent of women choose reconstruction, and the rest decide to skip it, citing things like not wanting another surgery and a fear of breast implants. And there are still no breast replacements that restore function—so the decision is purely a cosmetic one.
But for those who do want to reconstruct their breasts, options can be grouped into two categories: implant reconstruction and tissue reconstruction, which relocates tissue from elsewhere in the patient’s body. The two procedures can be combined—using a small implant and surrounding it with tissue, for example—and both have advanced a great deal in the past 10 years.
On the implant side, researchers are working to develop new materials that will last longer and feel more natural. Many surgeons are moving away from gel-like implants to so-called “form-stable” ones. These are often called “gummy bear” breast implants, because they’re more solid than their predecessors. “If you cut the standard silicone gel it will flow out very slowly like molasses,” explains Oscar Ochoa, a plastic surgeon at the PRMA Center for Advanced Breast Reconstruction in San Antonio, Texas, “but [with] these new ones, if you cut the implant down the middle, everything just stays where it is.” Gummy bear implants are still made of silicone, but doctors say they feel more realistic, and will keep their shape longer than other implants.
When it comes to tissue-based reconstruction, doctors have gotten better and better at grafting a person’s own tissue onto their breast. This tissue normally comes from the belly, thigh, or butt, and along with it the doctors harvest the skin, fat, and blood vessels, while leaving muscle behind. “So the technology has been focused on leaving everything that is nonessential for the breast in place, and only taking the stuff that’s needed for the tissue reconstruction,” explains Ochoa.
Different surgeons prefer different techniques. Ochoa is a fan of tissue reconstruction. “I’m biased towards it, I firmly believe it’s the best, most high quality reconstruction there is for the long term,” he told me. There are downsides—taking tissue from another part of the body means more incisions for the patient, a longer recovery period, a steep learning curve on the part of the doctor and the need for a larger team of trained medical professionals on hand. But Ochoa points to the downsides to implants too—the long term satisfaction with implants isn’t always high. They can lose their shape and firmness, and even rupture if the implant gets old. When using the patient's own tissue, Ochoa says the results are often better. “If you see a patient five to 10 years along the line it’s hard to see the scars. And if another physician were to see the patient they’d be hard pressed to tell a surgery had even taken place.”