
Join LBBC's efforts to
stop new limits
on breast reconstruction
A recent change to medical billing codes could imperil your access to DIEP flap surgery.
19 Min. Read
Breast reconstruction is the surgical process of rebuilding the breast during or after mastectomy or lumpectomy surgery. It involves using tissue, implants, or a combination of both to achieve a more natural-looking breast. While mastectomy and lumpectomy are part of treatment, breast reconstruction doesn’t treat the cancer.
Getting reconstruction is a personal choice. Many women choose not to have reconstruction. This is often called going flat. For some women, breasts are an intimate and essential part of their body image and sexual identity, and the idea of losing one or both breasts can trigger many intense emotions. If it’s upsetting to think about losing a breast, reconstruction can help restore a sense of wholeness. If you’re thinking about breast reconstruction, talk with your surgeon and plastic surgeon as early as possible to explore options and decide on timing that works best for your situation.
Breast reconstruction can often be done at the same time as mastectomy surgery, all in one step. It can also be done in multiple steps, with some steps happening during mastectomy and others happening in a later surgery. And it’s possible to wait weeks, months, or even years before having breast reconstruction surgery. Here are some situations that can affect timing:
If you’re having a lumpectomy and you’re concerned about how your breast will look after surgery, ask your surgeon about oncoplastic lumpectomy. This approach uses plastic surgery techniques during lumpectomy to reduce the risk of visible scarring or indentations. These techniques can also be used later to make corrections. If oncoplastic lumpectomy is not available where you are, partial breast reconstruction techniques can be used to correct imbalances left after lumpectomy. Visit lumpectomy to learn more.
There are two main types of reconstruction available today: reconstruction using your own body tissue, such as muscle or fat, and reconstruction using breast implants.
Tissue reconstruction, also called flap reconstruction, is a more complex surgery with a longer hospital stay and recovery time when compared with implant reconstruction. Still, reconstruction with a tissue flap often results in breasts that have a more natural look and feel than reconstruction using implants. To perform this type of reconstruction, a surgeon will take skin, fat, or muscle from a different part of your body and use it to reshape and rebuild the breast or breasts.
Types of flap reconstruction include:
Tissue flap reconstruction requires healthy blood vessels so that blood can get to the reconstructed breast or breasts. Certain medical conditions and lifestyle factors shrink or reduce blood vessels. Uncontrolled diabetes, poor circulation, connective tissue disease, and smoking can create challenges with this type of reconstruction surgery. If any of these apply to you, talk with your doctor about whether you’re eligible for this reconstruction approach. Visit Tissue reconstruction to learn more.
In implant reconstruction, a silicone-covered breast implant is placed under the muscle and skin of the breast. The implant contains either silicone gel or saline (salt water). Silicone implants feel like a natural breast in texture and shape, while saline implants feel less firm. Either type of implant may be a good option if you do not have very large breasts or there is not enough tissue available in other parts of your body to create a breast. There are pros and cons to choosing saline or silicone implants. Be sure to talk with your doctor about which may best suit you and your lifestyle. Visit Implant reconstruction for more information.
In some cases, depending on the location of the cancer, surgeons may need to remove the nipple and areola, the area around the nipple. Breast reconstruction techniques can rebuild the nipple and recreate the areola. In both tissue and implant reconstruction, you may have the option of rebuilding the nipple. There are different ways to create a nipple, including using the skin of the affected breast or other techniques. Nipple reconstruction is usually a separate surgery that happens a few months after the main breast reconstruction surgery. This allows the reconstructed breast or breasts to heal and settle into a final position first. Visit Nipple reconstruction for more information.
If you decide to have oncoplastic lumpectomy, flap surgery techniques can sometimes be used. Oncoplastic breast surgery and reconstruction techniques can also be used at some point after lumpectomy.
You and your surgeon will decide on a reconstruction plan and schedule that works best for your needs.
Join LBBC's efforts to
on breast reconstruction
A recent change to medical billing codes could imperil your access to DIEP flap surgery.
The best time to gather information about breast reconstruction is before mastectomy surgery. While you and your doctors may be very focused on treating the cancer, your sense of physical identity and body image are also very important. Some women may feel completely empowered to start a reconstruction conversation with their surgeon and ask about options. For others, it can feel like, “I should just be grateful to be getting rid of the cancer. It’s too much to expect to come out of this actually looking good, too!” But for many women, breast reconstruction can help restore a feeling of physical completeness, identity, and quality of life after a diagnosis.
If your surgeon does not talk with you about breast reconstruction, ask about it. While reconstruction can be done at the time of mastectomy or months or years later, understanding all your options before mastectomy can help you make the best decisions for you. Many women have the option of having some or all of the reconstruction at the same time as mastectomy — so the earlier you talk to your surgeon about reconstruction, the better.
We know that making such an important decision about your body can feel overwhelming. Here are some pros and cons of having breast reconstruction.
Breast reconstruction can:
It can also:
Think about how you feel about your breasts and your body. Breast reconstruction is a very personal decision. You have options. Take the time you need to decide which one makes most sense for you and your lifestyle.
To help you decide, you may want to:
Concerns about pain, stiffness, or other side effects after reconstruction can also inform your decisions. Ask a plastic surgeon about what kinds of short-term and long-term side effects can happen after different kinds of reconstruction, and how they can be managed. For example, the surgeon or nurse can show you exercises that can help lower the risk of post-surgery stiffness or manage it if it happens. Hearing experiences from others who’ve had breast reconstruction can help, too.
Not everyone is a candidate for breast reconstruction. Here are some conditions that may interfere with having reconstruction:
Smoking can also interfere with tissue reconstruction because it constricts blood vessels, the passageways oxygen travels through to reach healing skin. Smokers are at a higher risk for tissue necrosis, the death of skin cells from lack of oxygen. If you smoke or have other medical conditions and want reconstruction, talk with a plastic surgeon as soon as possible to find out your options. Your surgeon may recommend you quit smoking and quit using other nicotine products for a certain amount of time before and after surgery.
It’s important to find a plastic surgeon who listens to your goals and concerns. Along with the medical oncologist treating the cancer, your plastic surgeon can help you understand options and timing that work for your treatment plan.
In some cases, you may feel very comfortable with the first plastic surgeon you meet. In other situations, it can help to talk with more than one plastic surgeon. Some health insurance plans cover second opinion meetings with doctors. Talk with your health insurance company to understand if a second opinion visit is covered.
Here are some questions to consider asking when you meet your plastic surgeon for the first time:
If you are having trouble finding an experienced breast reconstruction surgeon in your area, you can ask your medical oncologist or breast surgeon to refer you to one or contact the American Society of Plastic Surgeons.
Your doctor may suggest you follow some general health instructions ahead of surgery to prepare your body for healing. It’s important to follow these instructions, so be sure to ask any questions you have when you get them.
At home, it can be helpful to have a place ready for you to sit with easy access to necessary items (such as water, food, and entertainment) and where you can sleep comfortably, such as a recliner. You can prepare this ahead of time or ask a friend or loved one to create this space for you.
When you leave the hospital, you will likely have temporary surgical drains attached to your body with small stitches near the surgery site. Drains are small, flexible tubes that suction accumulated fluid away from the surgery site. You will be given instructions on how to empty and clean the drains to help you avoid infection once you’re home. Your doctor may also recommend you avoid certain activities such as heavy lifting, intense sports or exercise, and some sexual activities for 4-6 weeks.
If you choose to have reconstruction with breast implants, surgery can sometimes be done all in one step, placing the permanent implant at the time of mastectomy. But in other cases, your plastic surgeon may recommend using two steps: a first surgery in which your surgeon places a temporary implant called an expander under the skin and muscle of your chest, where the permanent implant will eventually go. The expander is gradually filled with saline solution at in-office appointments over a period of weeks or months. This stretches the skin and muscle enough that the implant will fit comfortably beneath them. Once the skin and muscle have stretched enough, you’ll have a separate surgery to place the expanders with permanent implants.
If you have tissue reconstruction, the number of steps can vary. Some tissue reconstructions are completed all in one surgery at the time of mastectomy. For others, a plastic surgeon may include a second surgery for final adjustments. Most of the time, the expander phase is not needed for tissue reconstructions.
If you decide to have nipple reconstruction, this can be an extra step that happens after the main breast reconstruction surgery is finished.
In general, implant reconstruction has a shorter recovery time than tissue reconstruction. After implant reconstruction, healing and recovery can take about 4 weeks. For tissue reconstruction, it can take about 6-8 weeks. Tissue reconstruction means your body is healing from more than one area of surgery — the breast area and the location of tissue used to build the breast. Implant reconstruction can also involve fat transfer from another area of the body to supplement the implant.
During recovery, your motion may be limited because of pain or muscle tightness, and you may feel fatigued or weak. These are all common effects of major surgery. Be sure to keep track of how you feel and report any new or worsening side effects to your doctors. After the body has healed, physical therapy is sometimes recommended to retrain and strengthen muscles weakened by the surgery. Ask your plastic surgeon about physical therapists who have experience working with women recovering from mastectomy and reconstruction surgery.
Many women worry that reconstruction can make it difficult to diagnose potential future breast cancers. Know that research shows that reconstruction does not make it harder to find a new breast cancer. If you had a mastectomy, you may not be offered screening mammograms if there isn’t enough breast tissue to effectively perform one. But you’ll still get physical breast exams, and if an area of concern is found, a diagnostic mammogram will be done.
Any kind of major surgery comes with the risk of side effects. Here are the main side effects that can happen with breast reconstruction:
It’s important to know that there are ways to manage pain, tightness, capsular contracture, or breast asymmetry after surgery. These can include physical therapy and corrective surgery. If you are only having reconstruction done on one breast, the risk of an imbalanced look can sometimes be avoided by making surgical adjustments to the other breast. Group health insurance plans that cover mastectomy are required to cover mastectomy-related reconstructive surgeries, including procedures to one or both breasts that can create symmetry.
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