Breast Reconstruction
Every two minutes a woman in the United States receives a breast cancer diagnosis, and her life is forever changed. The scars from breast cancer treatment are often both emotional and physical. Breast reconstruction can help address both of those aspects.
Your doctor may recommend a lumpectomy – a surgical removal of a portion of the breast – or a mastectomy – a surgical removal of the whole breast – depending on the breast cancer diagnosis.
Many patients are not aware that legally, insurance companies are required to pay for breast reconstruction if the mastectomy was covered by insurance. The Women's Health and Cancer Rights Act (WHCRA) became federal law on October 21, 1998. Although the goal of this was to protect women with breast cancer that choose to undergo breast reconstruction, less than 23% of women are aware of their options for breast reconstruction.
Timing of Reconstruction
Immediate Reconstruction
You may be a candidate to begin your reconstruction at the time of your lumpectomy or mastectomy. This will be determined by your surgical oncologist and plastic surgeon. Tumor size and type, lymph node status, need for chemotherapy or radiation postoperatively, and nicotine use may influence whether or not this is the best option for you. Benefits of immediate reconstruction include fewer surgeries and the ability to recover from both your cancer surgery and reconstruction at the same time.
Delayed Reconstruction
Reconstruction after mastectomy can be performed weeks, months and even years later, depending on the scenario and patient desires. Delayed reconstruction allows you to focus on treating the cancer first. You and your plastic surgeon can then determine which reconstructive option is best for you. During this time without a breast, you may choose to obtain a prosthesis.
Types of reconstruction
Implant-Based
This type of reconstruction is where implants are used to reshape your breasts. Implant procedures can be divided into two types: Direct-to-implant (DTI) (One Stage) or Tissue-Expander-to-Implant Reconstruction (Two Stage). Direct-to-implant includes one surgery and tissue-expander-to-implant requires two stages of surgery. Implant-based reconstruction is the most common type of reconstruction. The surgery is confined to one area, which is advantageous, but typically implants require surgery in the future at some point for revision or replacement.
Tissue-Based
This is when tissue is removed from one part of the body and used to rebuild the breasts. The “flap” may come from the abdomen, back, thigh or buttocks and may be left attached to its blood supply and rotated to the breast (pedicled) or removed and transplanted to the breast with the use of a microscope (free flap). The advantage of this is that it is your own tissue and there is often little to no maintenance. These surgeries are more extensive requiring hospitalization 2-5 days, and you have two surgical sites to heal making recovery longer. Sometimes implants are still required to achieve the desired breast shape or size.
No Reconstruction
You may choose to not have reconstruction at all. This may be for personal reasons to get back to life faster or desire for a shorter recovery time. There are prostheses devices available if you do not have reconstruction, but desire to have a breast mound appearance in clothing.
Making the Decision That is Right for You
One of the joys of being a plastic surgeon is rather than removing diseased body parts, we get to use our skills to build and restore. While you don't have to choose breast reconstruction, you should at least be aware of every option. We will help you decide which breast reconstruction option is best for you based on your breast cancer, expectations, medical conditions, and emotional health. There is no wrong decision. You get to control whether or not you want breast reconstruction.
