Breast reconstruction decisions

If you have had or are considering mastectomy, you may feel many different emotions at the thought of losing a breast. While some women report feeling frightened, anxious, concerned, or sad, others say they feel comfortable and even relieved.

You have options for what to do next. Whether you choose to undergo breast reconstructioninfo-icon, to use a prosthesisinfo-icon, or to go flat, what matters is what is right for you. Understanding your options can help you make an informed decision.  

What is breast reconstruction?

Breast reconstruction is elective surgeryinfo-icon to rebuild the size and shape of the breast using body fat, muscle, or an implantinfo-icon. It can also replace your nippleinfo-icon and areolainfo-icon, the dark area around the nipple. If you choose to get an implant, donor tissue may be used to help keep it in place. Reconstruction does not treat breast cancer or increase your risk of cancer returning.

Most breast reconstruction occurs after mastectomyinfo-icon but may be possible after lumpectomyinfo-icon, or removal of part of the breast, and radiation therapyinfo-icon.

Often, breast reconstruction can be done at the same time as a mastectomy. It is also possible to wait weeks, months, or even years before having breast reconstruction surgery.

Who has breast reconstructon surgery?

In the United States, about 20 to 40 percent of women who have mastectomy have breast reconstruction surgery. You may be able to have breast reconstruction even if you finished treatment years or decades ago. In general, there are no age limits. If you are healthy enough to have surgery, you can have breast reconstruction.

In most cases, the breast cancer stageinfo-icon does not matter. Metastatic, aggressiveinfo-icon, or inflammatory breast cancers may need treatment first and prevent or delay reconstruction.

If you have a lumpectomy, it’s sometimes possible to have partial breast reconstruction. Your doctor may also call this oncoplastic surgery. Partial breast reconstruction is used to prevent or treat a breast that is misshapen or has asymmetry with the other side. It is sometimes done before radiationinfo-icon and sometimes after. If you are having a lumpectomy and think you may need breast reconstruction, talk with your surgeoninfo-icon as early as possible about your options. 

Some medical conditions may prevent reconstruction:

  • Diabetes that is not well controlled
  • Autoimmune diseases
  • Extreme obesity or thinness
  • Poor general health

If you smoke or have other medical conditions and want reconstruction, talk with a plastic surgeoninfo-icon as soon as possible to find out your options. Smoking constricts blood vessels, the passageways oxygen travels to reach healing skin. Smokers are at higher risk for tissueinfo-icon necrosis, the death of skin cells from lack of oxygen. Your surgeon may recommend you quit smoking and other nicotine products for a certain amount of time before and after surgery.

Talking to the plastic surgeon

It’s important to find a good fit when searching for a plastic surgeon. Your surgeon will help you decide whether to have immediate or delayed reconstruction. Your choice may depend on your cancer treatment plan and personal preferences.

Questions to ask surgeons you interview may include:

  • What percentage of your practice is breast reconstruction? How much experience do you have with it?
  • What kinds of breast reconstruction do you do?
  • Will you show me before-and-after photos of women with the type of reconstruction I’m considering?
  • May I speak to some of your patients about their experiences?
  • What are complicationinfo-icon rates in this practice, and what are the potential complications of my surgery?
  • If complications happen, how do you manage them?
  • What are the best and worst case scenarios for my procedure?
  • How long will my recovery be?
  • Will I need any follow-up or revision surgery?

It may be helpful to see a surgeon who does breast reconstruction more than a few times per year. If you are having trouble finding a plastic surgeon in your area, ask your oncologistinfo-icon or breast surgeon to refer you or contact the American Society of Plastic Surgeons.

Making decisions about breast reconstruction

The best time to gather information about breast reconstruction is before your mastectomy. If your provider does not talk about breast reconstruction, it is OK to bring it up. Whether you are newly diagnosed or undergoing treatment, you should feel empowered to seek full guidance on reconstruction options, even if you aren’t ready to do anything.

Some of the advantages of reconstruction you may consider are that it can

  • help restore your body imageinfo-icon
  • create a permanent breast shape
  • make your chest look and feel balanced
  • allow you not to wear a prosthesis

It’s also important to consider the potential disadvantages of reconstruction. These include:

  • it usually requires more surgeries than mastectomy without reconstruction
  • it has a higher risk of complications than mastectomy alone
  • it often requires a longer time to recover from surgery than mastectomy alone
  • you may not be happy with how your rebuilt breast looks or feels
  • with some procedures, it may cause scars on other areas of your body
  • you may need to have procedures in the future

Think about how you feel about your breasts and your body. Breast reconstruction is a very personal decision. You have options, and you can take your time to decide which one makes most sense for you and your lifestyle.

To help you decide, you may

  • talk with plastic surgeons with breast reconstruction expertise
  • look at photos of women before and after reconstruction. Some women may even be willing to show you their reconstructed breasts in person
  • speak with women about their experiences, including those who chose prostheses or chose to do nothing; if you don’t know anyone, contact our Breast Cancer Helpline at (888) 753-5222 to talk with a woman who made this decision
  • visit a store with mastectomy wear to see options
  • weigh the benefits of reconstruction against the possible risks of extra surgery
  • consider how you might handle the situation if your rebuilt breasts are not what you expected

Paying for breast reconstruction

Under the Women’s Health and Cancer Rights Act (WHCRA), group health insurance plans that cover mastectomy must also cover breast reconstruction. They should also cover surgery to the other breast for symmetry or balance, breast prostheses, and physical complications.

States also mandate reconstruction coverage. Check with your health insurance company to find out what your plan covers. All state Medicaid programs cover reconstruction.

Before you start, try to get estimates of how much things will cost, including the future stages of reconstruction. It’s also important to consider the non-medical costs of having more surgery, such as transportation costs and time off of work.

If you are uninsured or underinsured, you also may find help at My Hope Chest.

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April 2, 2018