Breast Reconstruction After Mastectomy

Breast reconstruction encompasses several different types of procedures that attempts to rebuild a breast's shape after a mastectomy. The specific type of reconstruction will depend on factors such as your age and body type. While it cannot give a woman back her breast – a reconstructed breast may not have normal sensations – the procedure does offer a result that looks like a normal breast.

Breast reconstruction typically involves several procedures performed in stages, and can either begin at the time of mastectomy or be delayed until a later date. In all of these procedures, the plastic surgeon forms and positions a breast mound using an implant or natural body tissue. And while the main focus is to add volume and size to the reconstructed breast, other procedures such as nipple addition, changing the size/shape of the new breast, and enhancing the opposite breast to match size are common as well. For example, you may elect to have a breast lift, breast reduction or breast augmentation on the other breast to achieve breast symmetry.

Important Note

• Your reconstructed breast will likely not have the same sensations as the breast it replaces
• You may have visible incision lines present on the breast, whether from reconstruction or mastectomy
• Depending on the type of breast reconstruction you choose, you may also have incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks

Is This a Good Option for You?

Breast reconstruction after a mastectomy may be a good option for you if:

• You are able to cope well with your diagnosis and treatment
• You do not have additional medical conditions or other illnesses that may impair healing
• You have a positive outlook and realistic goals for restoring your breast and body image

Although most women qualify as breast reconstruction patients, there are several factors that may disqualify you. Our highly trained and sensitive plastic surgeons will discuss this with you at the time of your consultation.

Breast Reconstruction Options

Timing

One of the first decisions a patient must make is what type of reconstruction procedure she will choose – and when. The breast reconstruction process can start at the time of your mastectomy or it can be done as a delayed procedure.

Immediate vs Delayed Reconstruction

Immediate Reconstruction:

• Timing - Begins at time of mastectomy and has become the standard of care for most patients.
• Advantages - Psychological and aesthetic boost when waking from the mastectomy procedure with a lesser deformity and reconstruction well underway.
• Disadvantages - Longer surgery and recovery time. Also subsequent radiation treatment can compromise the reconstructed tissue.

Delayed Reconstruction:

• Timing - When radiation is required as part of the treatment plan, the patient may want to delay reconstruction until after all treatments have been completed.
• Advantages - Gives you time to focus on treatment and research the type of construction that best suits your needs. In addition, your final result is usually better if you wait until after radiation treatments.
• Disadvantages - Being without a breast for an extended or unknown period of time can be emotionally challenging.

Implants or Your Own Tissue

Reconstruction generally falls into two categories: implant-based or autologous flap procedures (using a patient's own tissue). Factors to consider include the type of mastectomy, cancer treatments and your body type.

• Breast implants — silicone devices filled with silicone or salt water (saline) — are one option to reconstruct your breast following a mastectomy.
• Flap procedures – flaps are fashioned from your own body tissue to form a new breast mound following a mastectomy. Several flap procedures are performed by our surgeons:
  • DIEP flap
  • TRAM flap
  • TUG/DUG flap
  • LAT flap
  • SGAP flap

Nipple-sparing Mastectomy

Some women are opting for surgeries that remove the breast tissue but not the skin, nipple, and areola. An advantage of this procedure is that this procedure maintains your natural nipple and areola and minimizes the number of procedures that you will undergo. A disadvantage of nipple-sparing mastectomy is that the nipple and areola lose sensation.

Nipple-sparing mastectomy may be available for patients whose tumor is small and positioned away from the nipple. It may also be an option for patients undergoing preventive mastectomy or patients with ductal carcinoma in situ (a very early stage of cancer).

Nipple-sparing mastectomy is often performed when breast removal and reconstruction are completed during the same operation. If an axillary dissection or a sentinel lymph node biopsy is necessary, another incision is usually made in the armpit area.

Nipple Reconstruction

Having a nipple and areola tattooed onto your reconstructive breast is a simple and fast procedure that can be done in your plastic surgeon's office. Your surgeon will either match a new nipple to the one on your un-reconstructed breast, or if you had bilateral reconstructions, your surgeon can use your preoperative photos to recreate the nipple color, or you can pick a new color that you like against your skin tones.

Insurance Coverage

Breast reconstruction following cancer surgery is usually covered by health insurance policies. The Women's Health and Cancer Rights Act (WHCRA) includes protections for individuals who elect breast reconstruction in connection with a mastectomy. WHCRA provides that group health plans and health insurance issuers that provide coverage for medical and surgical benefits with respect to mastectomies must also cover certain post-mastectomy benefits, including reconstructive surgery and the treatment of complications (such as lymphedema).

• More information on the Women’s Health and Cancer Rights Act
• It is always good to check with your individual health insurance carrier for definitive information regarding your coverage.

More Information?

If you have further questions, or would like to schedule a breast reconstruction consult, please contact us.

Breast Reconstruction Words to Know

• Areola: Pigmented skin surrounding the nipple.
• Breast augmentation: Also known as augmentation mammaplasty; breast enlargement by surgery.
• Breast lift: Also known as mastopexy; surgery to lift the breasts.
• Breast reduction: Reduction of breast size and breast lift by surgery
• Capsular contracture: A complication of breast implant surgery which occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm.
• DIEP flap: Deep Inferior Epigastric perforator flap which takes tissue from the abdomen.
• Donor site: An area of your body where the surgeon harvests skin, muscle and fat to reconstruct your breast – commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
• Flap techniques: Surgical techniques used to reposition your own skin, muscle and fat to reconstruct or cover your breast.
• General anesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness.
• Grafting: A surgical technique to recreate your nipple and areola.
• Intravenous sedation: Sedatives administered by injection into a vein to help you relax.
• Latissimus dorsi flap technique: A surgical technique that uses muscle, fat and skin tunneled under the skin and tissue of a woman’s back to the reconstructed breast and remains attached to its donor site, leaving blood supply intact.
• Local anesthesia: A drug injected directly to the site of an incision during an operation to relieve pain.
• Mastectomy: The removal of the whole breast, typically to rid the body of cancer.
• SGAP flap: Superior Gluteal Artery perforator flap which takes tissue from the buttock.
• Tissue expansion: A surgical technique to stretch your own healthy tissue and create new skin to provide coverage for a breast implant.
• TRAM flap: Also known as transverse rectus abdominus myocutaneous flap, a surgical technique that uses muscle, fat and skin from your own abdomen to reconstruct the breast.
• Transaxillary incision: An incision made in the underarm area.
• TUG/DUG flap: Also known as transverse upper gracilis/diagonal upper gracilis, two similar types of breast reconstruction procedures that use a patient’s own tissue from the inner thigh to create a new breast after a mastectomy.