Beauty after Breast Cancer

What is Breast Reconstruction?

By Dr. Nicholas Tarola

Breast reconstruction is a physically and emotionally rewarding procedure for women who have lost a breast, usually due to cancer, that is aimed at restoring a woman’s sense of normalcy and breast symmetry in clothing without the need for an external breast prosthesis.

Who is a candidate for breast reconstruction?
Most women are candidates for some type of breast reconstruction procedure but there are a number of factors to consider when determining which procedure is most appropriate for each woman. These factors include the stage of breast cancer, need for radiation therapy, overall health status and the amount of recovery time a woman will allow herself.

What should I expect after breast reconstruction?
There are several plastic surgery techniques aimed at restoring a breast to a near-normal size and shape after mastectomy. Each technique will achieve a slightly different result. A woman can expect that the reconstructed breast will not have the same sensation and “feel” as her original breast. Scars on the breasts, or other areas of the body depending on the reconstruction technique used, are usually thin and fade with time.  If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts.

What should I expect in my consultation with a plastic surgeon?
Be prepared to discuss your goals and expectations of reconstruction. Your plastic surgeon will thoroughly review your medical history including medications, prior surgeries, and the use of tobacco or herbal supplements. Your surgeon will inform you of your available breast reconstruction options and the associated risks and potential complications. An examination will be performed and photographs will be taken. Finally, you and your surgeon will decide on a treatment course that is best for you.

What are the options for breast reconstruction?
Your reconstruction can be performed in either an immediate or delayed setting. If immediate, your reconstruction will be performed in the same operation as your mastectomy. If delayed, the reconstruction can be performed weeks to years following the mastectomy. Basically, there are three forms of reconstruction: Implant based reconstruction; autologous reconstruction; and a combination of autologous and implant based reconstruction. Implant based reconstruction is usually a 2-stage technique in which a tissue expander is placed during the first operation and then replaced by a permanent implant during a shorter second operation. Autologous reconstruction involves the use of tissue from another area of your body, usually your back or abdomen, to replace the skin and tissue lost as a result of the mastectomy. An implant is used in conjunction with autologous reconstruction if additional volume is required above and beyond that which is supplied by the tissue flap.

How much does breast reconstruction cost?
The cost for breast reconstruction can vary widely but is always a factor in any surgery.  Once a diagnosis of breast cancer is made or a woman is found to be at a significant increased risk for developing breast cancer, breast reconstruction following mastectomy and any subsequent revisions related to the reconstruction are almost always covered by health insurance.

What else should I know?
Breast reconstruction can be a lengthy, involved process but one that most women feel was worth it in the end.  Our goal as surgeons is to provide an excellent result based on realistic expectations and assist patients throughout the entire process whether it is smooth sailing or if road bumps are encountered.  Women who have reconstruction after a mastectomy may go through a period of emotional adjustment. Just as it takes time to get used to the loss of a breast, it takes time to start thinking of the reconstructed breast as your own. Talking with other women who have had breast reconstruction might be helpful. Talking with a mental health professional might also help you sort out anxiety and other distressing feelings.

Some questions you might ask yourself to determine if breast reconstruction is the right option for you include:

  • How important is rebuilding your breast to you?
  • Can you live with a breast form that you take off and put on?
  • Will breast reconstruction help you to feel whole again?
  • Are you OK with having more surgery for breast reconstruction after mastectomy or lumpectomy?

All mastectomy patients should at least discuss their options regarding reconstruction with a plastic surgeon certified by the American Board of Plastic Surgery.  Many women eligible for breast reconstruction following cancer surgery are not being informed of their options. All women should know their options. It’s time to close the loop on breast cancer.