What Is Breast Reconstruction Surgery?
Surgery to recreate breasts following a mastectomy is known as breast reconstruction. There are various forms of reconstruction for the breast, including implants or by using your own body tissue. A mastectomy can be followed immediately by breast reconstruction or breast reconstruction can be done later. A plastic surgeon performs the surgery. Though women receive breast reconstructions more often than men, men can also get the surgery if they choose.
What to Expect With Breast Reconstruction Surgery
It is best to locate a skilled plastic surgeon who is board-certified if you decide to have breast reconstruction. Your breast surgeon may recommend physicians to you. You can also get in touch with the American Board of Plastic Surgeons to see whether your surgeon is board certified or to locate a board-certified plastic surgeon in your region.
In order to fully understand your options before undergoing reconstruction surgery or even a mastectomy, you may wish to seek a second opinion before proceeding. It’s critical that you base your decisions on accurate and comprehensive information.
Prior to undergoing breast reconstruction, it is crucial that you ask your plastic surgeon all of your questions. Ask your surgeon about anything you don’t understand.
Just a few questions you can ask are:
- Is breast reconstruction an option for me?
- When can I get the surgery?
- Should I do it now, or is it better to wait?
- Will reconstruction interfere with future chemotherapy or radiation therapy?
- What are the risks and benefits? What type of reconstruction do you think I should have, and why?
- What is the cost?
- Will my insurance cover this?
- How many of these procedures have you done, and what were the success rates?
- What results can I expect?
- Could I have my nipple(s) reconstructed if I choose to?
- How will my reconstructed breast(s) feel?
- How will aging affect my reconstructed breast?
- How will I know if the implant is ruptured?
- Can you show me any photos of the surgery results?
Regaining confidence and feeling better about your appearance can be achieved through breast reconstruction; however, it is important to remember that the reconstructed breast will not be an exact replica of your natural breast. Your stomach, back, thighs, or buttocks will all look different after surgery if tissue from those areas is used.
The information about your surgery, including anesthesia, the length of the procedure, potential risks, what to expect afterward, and follow-ups, should be explained by your surgeon and any other participating physicians or staff.
Breast Reconstruction Procedure Options
Did you know that there are many different procedure options that you can look into? While not every option works for every person, here are the procedures that are the most popular.
Reconstruction With Implants
If there is enough tissue remaining on the chest wall after radiation therapy or a mastectomy to cover and support a breast implant, implant-based breast reconstruction might be an option. The most popular technique for tissue reconstruction forms a breast shape using fat and skin from the lower abdomen. Implant-based breast reconstruction can be accomplished using a variety of methods. Be sure to discuss which is right for you with your plastic surgeon. The most common methods are reconstruction above the pectoral muscle, reconstruction under the pectoral muscle, delayed breast reconstruction utilizing tissue expander, immediate breast tissue expander placement, and immediate breast reconstruction utilizing the latissimus dorsi muscle.
Reconstruction With Abdominal-Based Flaps
There are situations when there is not enough tissue left on the chest wall following a mastectomy or radiation treatment to cover and support a breast implant. In these situations, a flap technique — also referred to as autologous reconstruction — is typically needed for breast reconstruction. This is the most popular technique for tissue reconstruction; it forms a breast shape by using fat and skin from the lower abdomen. It is up to you to decide if you want an implant or not.
The tissue that you can pinch between your pubic bone and belly button is the skin and fat used in this procedure. You will usually have a scar around your belly button and from hip bone to hip bone after this tissue is removed to create a breast.
The lower abdominal tissue is used in a number of different flap procedures. The blood vessels that supply these flaps are what distinguish each of them from the others. These flaps are the free TRAM flap, the DIEP (deep inferior epigastric artery perforator) flap, the SIEA (superficial epigastric artery) flap, and the pedicled TRAM (traverse rectus myocutaneous) flap.
Following surgery, blood flow to the free TRAM, DIEP, and SIEA flaps is closely monitored in a hospital setting due to the microsurgical tissue transfer involved in these procedures. A repeat procedure to evaluate the blood flow might be required if there are worries regarding the flap.
Reconstruction With Thigh-Based Flaps
For women with small to medium-sized breasts, thigh-based flaps may be a good option; these flaps can also be combined with implants. Remember that these methods call for a high level of microsurgery expertise and training from your plastic surgeon.
The gracilis muscle, which is found in the upper inner thigh, is the foundation of gracilis-based flaps. Your particular thigh shape and the experience of your surgeon will determine which incision is best.
Using microsurgery, a PAP (Profunda Artery Perforator) flap reconstructs the breast using skin and fat from the back of the upper thigh. In this instance, no muscle is used.
Due to the microsurgical tissue transfer involved in these flaps, blood flow to the flap is continuously observed. Afterwards, healing issues with thigh-based flaps are typically greater than those with abdominal-based flaps due to the location.
Reconstruction With Gluteal-Based Flaps
Buttock skin and fat are used in gluteal-based flap procedures. The top buttock is home to SGAP (Superior Gluteal Artery Perforator) flaps. In order to reconstruct the breast, a flap of skin, fat, and blood vessels is transferred to the chest. Microsurgery is used to carefully reattach blood vessels. Comparably, tissue close to the crease at the bottom of the buttocks is used in the IGAP (Inferior Gluteal Artery Perforator) flap. Your buttock shape and the experience of your surgeon will determine the type of incision you need.
Due to the microsurgical tissue transfer involved in these flaps, blood flow to the flap is continuously observed. Techniques for GAP flaps are more involved and difficult than those for other reconstructions. It may be more difficult to mold the density of buttock tissue into a natural breast.
Breast Reconstruction Costs
Reconstruction costs following a mastectomy are frequently fully or mostly covered by health insurance policies, but this may not always be the case if you undergo reconstruction following breast-conserving surgery (lumpectomy or partial mastectomy). Verify your coverage by checking your policy, and find out how much of the bill you will be responsible for paying. Check to see if the kinds of reconstruction that are covered are restricted as well. Also, make sure your insurance company will cover the cost of a breast reconstruction before having surgery. Still, if your insurance plan tries to refuse coverage, your surgeon might be able to assist you with this.
Group health plans, insurance providers, and health maintenance organizations (HMOs) that cover mastectomy costs are required by the Women’s Health and Cancer Rights Act of 1998 to additionally cover the following costs:
- reconstruction of the breast (all varieties) removed during a mastectomy
- Surgery and reconstruction of the opposite breast when needed for symmetry
- Prosthetic breasts
- Handling of any post-operative complications, like lymphedema
However, certain government and church insurance plans are exempt from the Women’s Health and Cancer Rights Act, so be sure to check with your plan. Overall, your whole surgery (or at least much of it) should be covered if you have health insurance!
Potential Benefits and Risks
Of course, every surgery comes with benefits and risks. Let’s discuss what you can expect.
Benefits
- Improved self-confidence
- How your clothes will fit after surgery
- Comfort in a swimsuit
- Better intimacy with partner(s)
Risks
- Blood clots, especially after flap reconstruction
- Different breast sizes/shapes
- Areolas that aren’t symmetrical
- Bruising and/or scarring around the reconstructed breast(s)
- Fat necrosis — the death of transplanted tissue
- Wrinkling, rippling, or rupturing of an implant (if you had one inserted)
- Pain or sensitivity after surgery, including from the donor site
Luckily, many people who have gotten the reconstruction surgeries love their results, and only have minimal pain and discomfort. But as always, you should discuss with your surgeon about all potential risks.
Alternatives
Not sure if you’ll want reconstruction? That’s okay! There are two popular alternatives to the surgery that you can look into.
Breast Form/Prosthesis
If a woman has made the decision not to have reconstructive surgery but still wants the same appearance under her clothes, she can wear a breast form. To mimic the appearance and feel of a real breast, this can be worn on the outside of the body or tucked inside a bra.
An appropriately weighted form anchors your bra to prevent it from riding up and gives your body the balance it needs for good posture. These forms might feel too heavy at first, but they should eventually start to feel natural. Also, you may be able to get your regular bra altered if you choose to wear your breast form in a pocket inside of it. However, there are specific mastectomy bras that already have pockets sewed in.
Both reconstructive surgery and a breast prosthesis may not be covered by all insurance companies. Therefore, ensure that you have all the information before filing any insurance claims. Breast forms vary in price, and there are differences in insurance coverage for breast prostheses.
If you’re unsure on your coverage, make sure to get in touch with your health insurance provider to learn more about your benefits and the process for filing claims. Request prescriptions for your prosthesis and any customized mastectomy bras from your doctor as well. And, if you qualify, you may be able to cover part of these costs with Medicare or Medicaid. Altogether, if you have to pay out of pocket, price of breast forms, bras with pockets, and bra alterations may be deducted from your taxes as medical expenses.
Going Flat
If you don’t want to wear a form, you can also choose to go flat. Going flat shouldn’t cause any additional health problems for many women, especially if both breasts were removed. However, if you’ve only had one breast removed, you may experience back pain, balance problems, or posture problems. If you believe this could be a problem, discuss your options with your doctor.
If you choose to go flat, there are a few things to take into consideration. For example, while some women may find going flat appealing, others may find losing their nipples uncomfortable. Nipple prosthetics, which resemble real nipples in appearance and feel, are produced by certain companies using silicone or other materials. Also, they are easily removed after being fastened to the chest. That’s always an option if you feel you’re missing your nipples and want to be more comfortable in your clothing.
FAQs
How painful is breast reconstruction?
Like many women, you will likely feel weak and may experience pain for two to three weeks following surgery. There could be a tugging or stretching sensation around your breasts, and you may need pain medication for a week or two. However, you should anticipate feeling stronger and better every day. If not, please contact your doctor as soon as possible.
Do breasts look good after reconstruction?
While a reconstructed breast with an implant might not look or feel exactly like a natural breast, surgeries have gotten better over time to imitate the look and feel as close as possible. So while your breasts won’t be a perfect match, they will most likely still look good under clothing, and can boost your self-confidence.
Is it worth having a breast reconstruction?
For some women, it’s totally worth it. Breast reconstruction can restore your self-esteem and help you feel better about your appearance after a lumpectomy or mastectomy. However, bear in mind that the reconstruction won’t be an exact replica or replacement for your original breast.
How long do you have to sleep on your back after breast reconstruction?
Many surgeons note that sleeping on your back maintains the ideal alignment for breast healing. So many advise that you sleep on your back at least for the first eight to twelve weeks following surgery.
Can I go braless after breast reconstruction?
Yes, you can! But, you have to wait until you’ve healed. It is advised that following augmentation surgery, you wait at least six weeks before going braless. If you intend to engage in any physical activity after this time, you should continue to wear a supportive bra as this can help shield the breasts from harm or injury.
Why delay breast reconstruction?
The choice of immediate versus delayed reconstruction is influenced by a number of variables, such as your lifestyle, preferences, and stage of breast cancer, in addition to other things like whether you are receiving treatment. There are advantages to delaying breast reconstruction, such as having more time to weigh your options and finish the procedure without having an impact on how the reconstruction will look. However, every body is different, so feel free to talk to your doctors about the best options for you.
Breast Reconstruction – What to Expect After Breast Cancer Conclusion
It’s crucial to keep in mind that surgery and medicine are not exact sciences if you decide to have breast reconstruction. While positive outcomes are anticipated, there is no full guarantee. Also, it might not always be possible to get the best outcomes from a single surgical procedure. The secret to a successful surgery is to follow your doctors instructions, follow up as needed, and take care of yourself. Also, never forget that you are capable of standing up for yourself and feeling confident in the choices you make regarding your personal well-being.