Most Frequently Asked Questions about Reconstruction

Tissue Expansion Procedure
Tissue Expansion Procedure. Art © A.D.A.M.

What’s involved in breast construction and how is it done?

If you are having a mastectomy or bilateral mastectomy, your surgeon will ask you if you want to have additional surgery to have a breast reconstructed to replace the breast or breasts being removed to treat breast cancer or prevent getting cancer.

If you are interested in having reconstruction, your surgeon will refer you to a plastic surgeon, and he or she will explain your choices for reconstruction and answer any questions you may have about each choice.

You will learn that breast reconstruction surgery can be immediate or delayed. It can happen immediately following the surgical removal of your breast(s). In this immediate reconstruction, the plastic surgeon does the first stage of rebuilding your breast.

When reconstruction is delayed, the surgeon does the first stage, rebuilding the breast, after your chest has healed from the mastectomy and after you have completed adjuvant therapy.

There is a third option. It is referred to as immediate-delayed reconstruction. During this procedure, a tissue expander is put under the skin during the mastectomy surgery. It is put there to hold a space that can be used as an implant while the tissue taken out during the surgery is removed and examined. When the surgical team gets the results of the tissue examination, they decide whether the woman will need radiation therapy. If radiation is not needed, an implant can be placed where the tissue expander was with no additional delay.

If radiation therapy is needed, breast reconstruction will be postponed until after radiation therapy is over.

Plastic surgeons can reconstruct breasts with implants made of saline or silicone or from autologous tissue, which is tissue from anywhere else in the body.

How will I decide what reconstruction method is best for me?

You can usually choose the breast reconstruction method based on what is important to you, but there are treatment issues that need to be considered before you choose. Radiation can damage a reconstructed breast. If you need radiation therapy, that knowledge can affect your choice.

Other things that need to be considered in choosing the type of reconstructive surgery include: the size and shape of the breast that is being replaced, your age and health status, the availability of autologous tissue, and where your breast tumor is located.

If you are considering implants, know that:

  • You need to have sufficient skin and muscle after the mastectomy to cover the implant.
  • Implants are a shorter surgical procedure than reconstruction using your own body.
  • There may be follow up visits needed to inflate the expander and insert the implant.
  • Implants may not be appropriate if you have very large breasts.
  • Your implants will not last a lifetime; the longer you have implants, the more likely you are to have complications and need to have your implants removed or replaced.

    If you are using your own body tissue for reconstruction, know that:

    • Using your own body tissue is a longer surgical procedure than with implants and there is more blood loss.
    • It may take you longer to recover.

    As with any surgery, there is the risk of complications, which you need to ask about when meeting with the plastic surgeon.There is always the chance that reconstruction may not be successful if you do not heal properly.

    Will I need follow-up care?

    Whatever reconstruction type you choose, it may increase the side-effects you experience, especially when compared with having a mastectomy only. It is important to keep your surgeon aware of any problems you are having post-surgery.

    Will health insurance cover my reconstruction?

    You need to speak with your insurance carrier before committing to reconstruction to make sure you are covered.  In 1999, the Women’s Health and Cancer Rights Act (WHCRA) mandated that group health plans, insurance companies, and HMOs offering mastectomy coverage also pay for reconstructive surgery following a mastectomy. Coverage includes: reconstruction of the other breast for a more balanced look, treatment of mastectomy complications, including lymphedema, and breast prostheses.

    While Medicare covers reconstruction, Medicaid coverage for reconstruction may vary by state. It is best to check what your state’s Medicaid coverage provides when considering reconstruction.

    Will I need annual mammograms of my reconstructed breast(s)?

    If you have one breast removed by mastectomy, you continue to have mammograms of the other breast. If you have a skin-sparing mastectomy, or are at high risk of breast cancer recurrence you may have mammograms of the reconstructed breast if it was reconstructed using your own tissue. Mammograms are usually not done on breasts reconstructed with an implant.

    Reconstruction sometimes takes multiple surgeries. It is important to understand the entire process, including potential side effects, before committing to having reconstruction.

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