- Overview
- Types of Breast Reconstruction
- Past Controversy over Silicone-Filled Breast Implants
- Finding a Plastic Surgeon
- Possible Complications With Breast Reconstruction
- Advantages and Disadvantages to Immediate Breast Reconstruction
- Breast Imaging After Reconstruction
- Additional Resources and References
The majority of women diagnosed with breast cancer will undergo some type of breast surgery as part of their treatment. For many simple or modified radical mastectomy patients, breast reconstruction may be possible during the same surgical procedure (this is called immediate breast reconstruction). However, there are advantages and disadvantages to immediate breast reconstruction:
Advantages to immediate breast reconstruction:
- Patients do not wake up to the "shock" of losing a breast.
- Patients may avoid additional reconstructive surgery.
- Many doctors agree that the best-looking results occur when the cancer surgeon and the plastic surgeon plan the operation together.
Disadvantages to immediate breast reconstruction:
- Patients may find it emotionally difficult to weigh all of their breast reconstruction options while also dealing with their recent breast cancer diagnosis and treatment alternatives.
- If surgeons find that the cancer is more advanced than they initially thought, breast reconstruction may interfere with treatment (such as chemotherapy or radiation therapy).
Some doctors recommend that women who need radiation therapy after breast surgery have delayed breast reconstruction. Though radiation after the insertion saline implants or muscle flap procedures may potentially distort the breasts, this is rare. Radiation therapy can usually be administered to patients after breast reconstruction without any significant consequences.
Usually women who have breast reconstruction may choose to have the nipple and areola (the pigmented region surrounding the nipple) reconstructed during additional surgeries. Nipple and areola reconstruction occurs after the breast has had time to settle after the initial reconstructive surgery. Tissue for the nipple can be taken from the newly created breast, the opposite nipple, or even the ear. Tissue for the areola can be taken from the upper inner thigh. To match the other nipple and to create the areola, tattooing may be done.
The American Cancer Society suggests breast cancer patients ask their plastic surgeons the following questions before having breast reconstructive surgery:
- Am I a candidate for breast reconstruction?
- When can I have reconstruction?
- What types of reconstruction are possible for me?
- What is the average cost of each type of reconstruction and does insurance typically cover them?
- What type of reconstruction is best for me? Why?
- How much experience do you (plastic surgeon) have with this
- procedure?
- What results are realistic for me?
- Will the reconstructed breast match my remaining breast in
- size?
- How will my reconstructed breast feel to the touch?
- Will I have any feeling in my reconstructed breast?
- What possible complications should I know about?
- How much discomfort will I feel?
- How long will I be in the hospital?
- Will I need blood transfusions?
- If so, can I donate my own blood?
- How long is the recovery time?
- When can I begin to exercise? Play sports?
- Are there any patients I can speak with who have had the same surgery?
- Will reconstruction interfere with chemotherapy?
- Will reconstruction interfere with radiation therapy?
- How long will the implant last?
- What kind of changes to the breast can I expect over time?
- How will aging affect the reconstructed breast?
- What happens if I gain or lose weight?
- What new reconstruction options should I know about?(1)
Health Insurance Coverage for Breast Reconstruction
Health insurance companies should cover the cost of breast reconstruction after mastectomy. However, patients may be responsibilty for a co-pay or portion of the cost, depending on the terms of insurance. In 1998, the Women's Health and Cancer Rights Act was passed, which requires all health insurance providers who cover mastectomy procedure to also cover the costs of breast cancer reconstruction for mastectomy patients. Under this legislation, insurance companies who cover the cost of mastectomy must also cover the costs of the following:
- reconstruction on the post-mastectomy breast
- surgery and reconstruction on the other breast to create symmetry
- breast prostheses
- treatment of complications from mastectomy, including lymphedema (chronic swelling) of the arm
It is important for women who have had breast reconstruction to continue receiving yearly mammography on the normal breast. Women who have had breast reconstruction should also practice monthly breast self-examination (BSE) and have yearly clinical breast exam. Click here to learn more about the guidelines for early detection of breast cancer.
Many radiologists do not take screening images of the area where the breast was removed (even if an implant or tissue flap is present) unless there is a clinical concern (for example, a new lump is found). Imaging breasts with implants requires a radiologist to take several special mammography views so he or she may see both the breast tissue and the implant. For this reason, diagnostic mammography is usually performed on women after breast reconstruction. Diagnostic mammography involves pinpointing the exact size and location of breast abnormalities as well as imaging the surrounding breast tissue and lymph nodes. Click here to learn more about mammography with breast implants.
In addition, women who receive silicone-filled breast implants are recommended to have MRI breast screening three years after implantation and every two years thereafter to screen for possible silent rupture.
- The American Cancer Society provides information on all aspects of breast reconstruction at http://www.cancer.org/.
- American Society of Plastic Surgeons provides information on breast reconstructive options at http://www.plasticsurgery.org/
- To learn about advances in breast reconstruction, please visit http://www.imaginis.com/breasthealth/advances_breast_reconstruction.asp
Updated: May 2010
