Breast Reconstruction

Who is a candidate?
Any woman who is going to have or has had a unilateral or bilateral mastectomy is a candidate for breast reconstruction. Occasionally, breast reconstruction is also necessary to correct post-lumpectomy changes in breast shape or size.

Should my reconstruction be immediate or delayed?
In most situations an immediate breast reconstruction (done at the time of the mastectomy) is appropriate. The advantage of this approach is that you wake up from the surgery with a new breast, or the beginnings of a new breast, already in place. In addition, when the breast reconstruction is performed immediately, the soft tissue envelope is not allowed to heal and contract, which often enhances the eventual reconstructive result. There are some instances where Dr Turowski and Dr Lu will recommend a delayed reconstruction, but this decision is made on an individualized basis.

Where are the scars after breast reconstruction?
This depends on the type of reconstruction performed. With a tissue expander/implant based reconstruction, the scar created from the mastectomy provides access for the breast reconstruction. With a latissimus dorsi flap reconstruction, there is an additional scar on your back. With a TRAM flap reconstruction, there is an additional scar on your lower abdomen, analogous to that created during an abdominoplasty or “tummy tuck.”

Will the reconstructed breast be symmetric to the existing breast?
In cases of unilateral reconstruction, every attempt is made to create a balanced, natural appearing reconstructed breast. This may require staged surgeries. In addition, Dr Turowski and Dr Lu may recommend a surgery on the contralateral breast (such as a breast augmentation, reduction, or lift) to make matching the reconstructed breast easier or making overall improvement in your appearance. In cases of bilateral reconstruction, symmetry is often obtained because the same reconstructive technique is applied to both breasts.

Will the reconstructed breast have sensation?
A reconstructed breast usually does not have normal sensation that existed before the surgery, but most women find that some sensation returns after several months.

What is the recovery after breast reconstruction?
This depends on the type of reconstruction. After a tissue expander/implant reconstruction, you can expect the stay in the hospital for 24-48 hours. For a latissimus dorsi flap reconstruction, hospitalization ranges from 2-3 days. After a TRAM flap, you can expect a 3-5 day hospital stay.

Pain medications are typically required for 1-2 weeks, and activity is gradually increased over a several week period of time. Occasionally, we recommend physical therapy after breast reconstruction to regain mobility and strength.

What is done for restoring the nipple and areola?
The final stage of breast restoration takes place after the breast mound is created. Initially the nipple is reconstructed using local tissue, and then medical tattooing is performed to restore the color of the areola. Both of these are performed as minor office procedures.

Can breast cancer recur after breast reconstruction?
In rare instances, breast cancer can recur after a lumpectomy or mastectomy with or without reconstruction. Modern techniques, such as mammogram, ultrasound, and MRI, allow detection of breast cancer recurrences even in the setting of a reconstructed breast. Your team of physicians will monitor you for recurrences with the appropriate tests after your mastectomy and reconstruction. Several studies showed no difference in recurrence detection or patient survivals in patient with or without reconstructions..

Does insurance cover breast reconstruction?
Insurance companies and managed care organizations are now required to pay for breast reconstruction for women who have had a mastectomy. Health care plans are also required to pay for surgery to make the opposite natural breast match the reconstructed breast. The Women's Health and Cancer Rights Act of 1997, which ensures these rights, states that:

    "A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall ensure that, in a case in which a mastectomy patient elects breast reconstruction, coverage is provided for:

  1. All stages of reconstruction of the breast on which the mastectomy has been performed; and
  2. Surgery and reconstruction of the other breast to produce a symmetrical appearance;
    in the manner determined by the attending physician and the patient to be appropriate, and consistent with any fee schedule contained in the plan."

This law is also observed by Medicare and Medicaid. However, you should still check with your insurance company ahead of time - most companies require that you obtain authorization in advance about any surgery that is not an emergency. Also, not all insurance companies cover nipple tattooing, so ask about this procedure if you think you would like to have it done. If you do not have insurance, you should talk with your doctor about the cost of the breast reconstruction surgery and office visits.

back to Surgical Procedures