Christina Applegate Chose Breast Reconstruction: Here's What To Know

Deciding whether or not to get breast reconstruction post-breast cancer is a difficult choice.

Breast surgery consultant meeting with female patient

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In 2008, Christina Applegate announced that she was diagnosed with breast cancer. The then 36-year-old actress had a prophylactic double mastectomy after finding a tumor in one breast and testing positive for the BRCA-1 breast cancer gene mutation, which elevated her risk for breast and ovarian cancer.

After her surgery to remove both breasts, Applegate decided she would undergo breast reconstruction over the next several months.

Types of Breast Reconstruction

There are two main types of breast reconstruction: implant or tissue (flap) reconstruction.

Breast reconstruction surgery has come a long way, with advances such as improved silicone implants, fat injections that can correct deformities from lumpectomies, and tissue reconstruction.

Reconstruction Using an Implant

Applegate had an implant expander and an implant for her breast cancer reconstruction.

After all the breast tissue is removed during a mastectomy, you can choose to have an immediate reconstruction, which happens during the same surgery as the mastectomy, or a delayed reconstruction, which is done at a separate surgery, usually months after the mastectomy. With both options, the procedure is the same:

  • A temporary expander, which is like a water balloon, is put into each breast.
  • The expander is gradually filled with water at visits with your healthcare professional to stretch the skin so that there is enough of it to cover the implants.
  • In another surgery, the expander is removed, and the implant is inserted during a second surgery.
  • If you choose to, after a few months, the areola and nipple can be created on each breast.

Reconstruction Using Body Tissue

In this type of surgery, called autologous tissue reconstruction or, more simply, a flap procedure, your skin, fat, and blood vessels from another part of your body are used to create a flap of tissue molded to look like a breast. The tissue usually comes from the back or abdomen, but the thigh or buttocks can be used too. There are two types of flaps.

A pedicle flap stays attached to the body while moving from one area of the body, usually the back or the abdomen, to the breast area, protecting the blood supply to the flap.

A free flap is just like it sounds—it's cut free from the originating area of the body and moved to the breast area, where it is shaped into a breast and reattached to restore blood supply.

Risks and Side Effects of Breast Reconstruction

If you are considering reconstruction, talk with your healthcare provider, ideally a surgeon or plastic surgeon, before your mastectomy. Aside from the usual risks to surgery, such as bleeding, infection, fatigue, anesthesia risks, and poor wound healing, here are some risks of breast reconstruction:

  • Loss of sensation or sensitivity of the nipple or breast
  • Uneven breasts
  • The need for additional surgery to correct problems
  • Changes in the arm on the same side as the reconstructIssueslems with the flap, such as loss of sensation or tissue death (necrosis)
  • Problems with the donor site of the flap, such as loss of sensation, dimpling, or bulging
  • Problems with the implant, such as movement, rupture, leaking, scar tissue build-up
  • A rare cancer linked to breast implants called implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of non-Hodgkin lymphoma

Reasons People Have Breast Reconstruction Surgery

A study found that people chose reconstruction after mastectomy mainly for appearance or emotional reasons. However, it can be a bit more complex than that. The specific reasons are personal and can vary:

  • To make the breasts equal in size or shape
  • To make clothes fit better
  • To feel feminine or better about themselves after mastectomy
  • To avoid seeing only a scar and no breast
  • To avoid using an external prosthetic that sits in the bra

If you have medical concerns such as smoking, obesity, diabetes, or circulatory problems, your healthcare provider may tell you to delay reconstruction until you heal from the mastectomy. In some cases, breast reconstruction may not be an option if you have chronic health problems or your immune system isn't strong enough.

You may also be told to wait if you'll be having radiation or chemotherapy after mastectomy as part of your breast cancer treatment.

Reasons People Don't Have Breast Reconstruction Surgery

Yet not all people who have their breasts removed choose reconstruction. Why not?

Some aren't good candidates because they're going to undergo radiation first, said Amy Alderman, MD, a plastic surgeon at North Atlanta Plastic Surgery in Alpharetta, GA.

"Others may be overwhelmed with the whole process. They're being told about radiation, chemotherapy, what's going to be done with their breasts or lymph nodes," Dr. Amy Alderman said. "They're glad to know about options but will decide later." Of those, about one-third of them will eventually opt for some kind of reconstruction, Dr. Amy Alderman added.

For some people, reconstruction is not a priority. "When they get to be 60 or over, I see more of the population saying, 'This isn't important to me,'" said Dr. Amy Alderman.

The most common reason for not undergoing reconstruction surgery is the fear of surgical risks and complications. Some other reasons:

  • Wanting to focus on recovery from mastectomy over aesthetics
  • Not wanting to have additional scars from the reconstruction
  • Having self-perception of being too old for the surgery
  • Having an acceptance of your body after a mastectomy

Racial Disparities in Reconstruction Surgery

A 2017 review noted that African Americans are less likely than white Americans to choose breast reconstruction surgery after a mastectomy. Possible reasons for this include not having access to the information they need or a reconstruction team with a plastic surgeon, or facing financial or insurance barriers, Dr. Amy Alderman said.

Some people may not know that insurance coverage for post-mastectomy breast reconstruction is mandated by the 1998 Women's Health and Cancer Rights Act.

A Quick Review

A breast cancer diagnosis and having a mastectomy are life-changing events, so choosing to have additional surgery to reconstruct your breasts may not be on your radar. There are two main types of breast reconstruction—using implants or using your tissue. Just like any surgery, both have their risks and benefits. Have a conversation with your healthcare provider, ideally a surgeon or plastic surgeon, before your mastectomy to discuss the pros and cons of reconstruction and how it would fit into your breast cancer treatment.

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  2. American Cancer Society. Breast Reconstruction Using Implants.

  3. National Cancer Institute. Breast Reconstruction After Mastectomy.

  4. American Cancer Society. Should I Get Breast Reconstruction Surgery?

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  6. Manne SL, Topham N, Kirstein L, et al. Attitudes and decisional conflict regarding breast reconstruction among breast cancer patientsCancer Nursing. 2016;39(6):427-436. doi:10.1097%2FNCC.0000000000000320

  7. Tarkowski R, Szmigiel K, Rubin A, et al. Patient’s education before mastectomy influences the rate of reconstructive surgeryJ Canc Educ. 2017;32(3):537-542. doi:10.1007/s13187-016-0982-9

  8. Soni SE, Lee MC, Gwede CK. Disparities in use and access to postmastectomy breast reconstruction among African American women: a targeted review of the literatureCancer Control. 2017;24(4):107327481772905. doi:10.1177/1073274817729053

  9. American Cancer Society. Women's Health and Cancer Rights Act.

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