Discuss With Your Doctor
Many women are not aware of their options or the fact that health insurance companies will pay for the reconstructive surgeries after mastectomy.
Depending on location and resources, women with breast cancer are not always offered the option of meeting with a plastic surgeon to discuss breast reconstruction after mastectomy.
If you are not offered this option, speak up. Ask your breast surgeon for a consultation to discuss if breast reconstruction is appropriate for you.
There are many factors to consider before undergoing a breast reconstruction after a mastectomy. Here are some questions to ask your surgeon before choosing the best type of surgery for you:
- Am I a good candidate for breast reconstruction surgery?
- Would you recommend reconstruction surgery immediately after my mastectomy, or should I wait?
- How should I prepare for surgery?
- Will my new breasts look similar to my old breasts?
- How long is the recovery time?
- Will reconstructive surgery interfere with any of my other breast cancer treatments?
- If I choose to use implants for my reconstruction, will the implants ever need to be replaced? How long do they last?
- What kind of wound care will I need to do at home?
- Will I need a caregiver of some kind after surgery?
Recovery From Breast Reconstruction Surgery
You may have some discomfort for the first few days afterward. Youâll get pain medication as needed. Throughout your hospital stay, the staff will closely watch you.
Soon after surgery, youâll be encouraged to move your arms, but not for any forceful activity like pulling yourself up, getting out of bed, or lifting heavy objects. Nurses will help you in and out of bed. The day after surgery, you may be able to sit in a chair beside the bed. On the second day, most patients are walking without help.
Youâll probably get IV fluids for a day or two. You may have a urinary catheter overnight or until you can walk to the bathroom. And where the surgeon made cuts , youâll have drains. If you go home with these drains in place, youâll get instructions on how to care for them.
The length of your hospital stay depends on the type of operation and how your recovery goes. If you got implants, the average hospital stay is 1 to 2 days. Flap procedures may require a stay of 5 to 6 days.
Finding And Paying For Breast Prostheses
Prices for breast forms vary considerably. High price doesn’t necessarily mean that the product is the best for you. Take time to shop for a good fit, comfort, and an attractive, natural appearance in the bra and under clothing. Your clothes should fit the way they did before surgery.
Insurance coverage of breast prostheses is not all the same. Be sure to contact your health insurance company to find out what will be covered and how you must submit claims. Also, ask your doctor to write prescriptions for your prosthesis and for any special mastectomy bras. When purchasing bras or breast forms, mark the bills and any checks you write “surgical.”Medicare and Medicaid can be used to pay for some of these expenses if you are eligible. The cost of breast forms and bras with pockets and the cost of having a bra altered might be tax deductible. Keep careful records of all related expenses.
Some insurance companies will not cover both a breast prosthesis and reconstructive surgery. That can mean that if you submit a claim for a prosthesis or bra to your insurance company, in some cases the company will not cover reconstruction, should you choose this procedure in the future. Make sure you get all the facts before submitting any insurance claims.
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How Do Surgeons Reconstruct The Nipple And Areola
After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction .
Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.
A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts .
Smoking And Body Weight
Smokers and women who are overweight have an increased risk of complications for all types of breast reconstructive surgery .
If you smoke or are overweight, talk with your plastic surgeon about problems that may occur after surgery with implant or flap procedures, such as delayed wound healing, infection and reconstruction failure.
Sometimes, its best to delay breast reconstruction until after quitting smoking or losing weight to lower these risks.
Your plastic surgeon or health care provider may discuss ways to quit smoking and/or lose weight before you have reconstruction.
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Helping Yourself Before Breast Reconstruction
You will recover more quickly after reconstruction surgery if you do the following things before your operation.
Stop smoking
Smoking can damage blood supply to tissue. It can also increase your risk of getting an infection. If tissue is taken from your tummy , smoking increases the risk of hernia.
Maintain a healthy weight
There is an increased risk of complications from an anaesthetic if you are overweight. Ask for a referral to a dietitian if you would like to lose weight before the operation.
Keep physically active
It can be useful to do sit ups if tissue is going to be taken from your tummy . You could aim to build up to 30 sit ups a day. Talk to your doctor or specialist nurse before starting any exercise.
What Types Of Breast Reconstruction Are Available
You will work with your surgeon to decide which type of breast reconstruction is right for you. Your surgeon and you will take into consideration your personal preferences for surgery, recovery, and results, as well as your body shape, prior surgeries, cancer treatments and overall health.
Breast reconstruction often requires multiple operations and significant recovery time. All breast reconstruction has risks and benefits. Its important to weigh your options carefully and follow care instructions from your doctor to reduce the risk of complications.
Learn more about Banner MD Andersons breast reconstruction program and the types of breast procedures available:
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Breast Reconstruction In A Private Hospital
You can choose to pay for treatment as a private patient even if you don’t have private health insurance. If you choose to have breast reconstruction surgery through the private health system, there can be considerable out-of-pocket expenses, even if you have a high level of private health insurance. Some women have told us that their out-of-pocket expenses have reached up to $15,000, while others report much less.
“I had private health insurance, but having said that, we were still out of pocket by more than $12,000.” — Lyn
Its important to ask your surgeon for a written quote before committing to any surgery. Some specialists are willing to negotiate their fees if you ask them. If you are not happy with the quote you receive, you can ask your GP or surgeon for a referral to another surgeon.
If you have private health insurance, you may like to ask your fund what is covered by your insurance and what the gap will be between how much you are charged and how much is paid by your fund. There can be a substantial gap between the cost of surgery and the amount you receive from your insurance fund that is not covered by Medicare. You can also ask your fund for the names of any plastic or reconstructive surgeons who have entered into gap cover agreements with them. If your surgery is provided by a surgeon who has a gap agreement with your fund, the surgeon will charge your health fund directly and there should be no out-of-pocket cost to you.
Why Choose Msk For Breast Reconstruction
Theres a lot on your shoulders right now. MSK can help make these challenging times easier for you.
Take comfort in knowing our surgeons are highly trained and internationally recognized for their expertise in all types of breast reconstruction. They perform hundreds of surgeries every year, including complex reconstructions and revision surgeries on women who are unhappy with their original reconstruction. At MSK, our surgeons collaborate with medical oncologists, dermatologists, radiation oncologists, and more on each patient so we can evaluate and meet your goals and minimize recovery time. Ultimately, we want to help you get back to being you.
When you choose MSK, youll also find compassionate care from talented nurses, exceptional rehabilitation programs, and integrative medicine specialists. And to help you feel your best on the inside, MSK offers a range of emotional support resources, both online and in-person.
What I love about is that they were so honest. They said, ‘You made the right decision for you.’ I needed my doctor saying that to me.”
JMireille Bueti
age 45, bilateral mastectomy with implants
The entire experience felt like my decision. I never felt persuaded. I was given all the options. I didn’t feel alone. I felt very comfortable and confident in all my doctors. That played a huge role.
Jaclyn Stout
age 29, bilateral mastectomy with implants
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Breast Reconstruction In A Public Hospital
There is no charge to you if you have your breast reconstruction through the public health system. If you would like to consider this option, your breast surgeon or breast care nurse can refer you to a public hospital that offers reconstruction surgery. Not all public hospitals are able to provide reconstruction surgery and waiting times will vary from hospital to hospital and across different states and territories. You can talk to your treating team about what’s available and where you can go to have your preferred procedure.
If you are considering an immediate reconstruction and would like to have your surgery in a public hospital, it is important that you talk to your breast surgeon about this as soon as possible. If you are seeing a surgeon who works only in the private sector, you may need a referral to someone who works in a public hospital.
If you choose to have delayed reconstruction at a public hospital, you will be put on the hospitals elective surgery waiting list. Waiting times can be up to two years or more in some places. Keep in mind that you can shop around to find a hospital where the waiting list times are shorter.
It is possible to put your name on a public hospital waiting list even if youre not sure that you will want a reconstruction. Try to do this as soon as you can. You can then use the waiting time to explore your options and make your decision. If you decide not to have a reconstruction, you can remove your name from the waiting list.
Deciding Whether To Have Breast Reconstruction
Choosing whether or not to have breast reconstruction is a very personal decision. Some women feel reconstruction is necessary to restore their confidence others prefer to wear an external breast form and some women choose not to have reconstruction and not to wear a prosthesis.
You may choose to , which can be a good option if you dont want to decide straight away. If you decide not to go ahead, this doesnt mean you wont be able to have one later.
Theres no right or wrong choice and its important to do whats best for you. It can be helpful to talk to other women who have had breast reconstruction before making your decision. Your breast care nurse may be able to arrange this. Breast Cancer Now can also put you in touch with someone who has had the type of breast reconstruction you are considering, through our Someone Like Me service.
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How Do Surgeons Use Tissue From A Woman’s Own Body To Reconstruct The Breast
In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a womans body and used to rebuild the breast. This piece of tissue is called a flap.
Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
Depending on their source, flaps can be pedicled or free.
- With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
- With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
Abdominal and back flaps include:
Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who dont have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.
Natural Tissue Flap Surgery
Reconstruction using skin and soft tissue flaps from your own body tends to mimic the look and feel of a natural breast better than reconstruction with implants.
However, these procedures are more invasive and complex. So, they usually require a longer hospital stay and a longer recovery time.
They require surgery to the area of the body where the tissue for the reconstruction is taken . The surgery will leave scars at the donor site.
The most common natural flap procedures use tissue from the abdomen or back. Flaps can also be taken from the buttocks or thighs .
In some procedures, part or all of a muscle needs to be taken to provide blood flow to the flap tissue. This may cause weakness in that area of the body and limit certain physical or athletic activities. If youre active, discuss this risk with your plastic surgeon.
Learn about managing pain after reconstructive surgery.
The latissimus dorsi muscle flap procedure removes a large muscle from the back along with skin and underlying fatty tissue. It uses these tissues to reconstruct the breast.
In most women, the amount of soft tissue available on the back is limited and the flap itself is only about an inch thick or less. So, an implant is usually needed to create enough volume for the reconstructed breast.
The fatty tissue of the latissimus flap goes over the implant, so it mimics the look and feel of a natural breast better than an implant alone.
The TRAM flap has some drawbacks:
The DIEP flap has some drawbacks:
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When Is Reconstructive Surgery An Option
In the case of partial mastectomy, if a large area of the breast is removed, one could consider oncoplastic surgery, which is surgery that involves both a breast surgeon and plastic surgeon to reconstruct part of the breast. The main types of reconstruction are implant based reconstruction and tissue reconstruction using tissue from the persons own body. Theres also nipple reconstruction, which can involve a small operation to create the nipple bud or a tattoo.
Recovering From A Mastectomy: What To Expect
In general, women having a mastectomy stay in the hospital for 1 or 2 nights and then go home. How long it takes to recover from surgery depends on what procedures were done, and some women may need help at home. Most women should be fairly functional after going home and can often return to their regular activities within about 4 weeks. Recovery time is longer if breast reconstruction was done as well, and it can take months to return to full activity after some procedures.
Ask your health care team how to care for your surgery site and arm. Usually, you and your caregivers will get written instructions about care after surgery. These instructions typically cover:
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Who Can Have A Breast Reconstruction After A Mastectomy Or Breast
Most women who have had a mastectomy, and some who have had breast-conserving surgery, can have either immediate or delayed breast reconstruction.
National guidance says the choice of immediate breast reconstruction should be discussed with anyone having a mastectomy. However, a delayed reconstruction may be a better option for some people. All suitable breast reconstruction options should be offered and discussed, even if they are not available locally.
Some people are advised not to have a breast reconstruction because of other existing medical conditions that might increase the risk of complications following surgery.
If its likely youll need radiotherapy this may affect the options and timing of breast reconstruction. Radiotherapy can increase the risk of hard scar tissue forming around an implant. This is known as capsular contracture. Capsular contracture can also affect a reconstruction that uses your own tissue, making the breast feel firmer, reducing its size and possibly altering its shape. Because of this, if radiotherapy is a likely treatment you may be advised to delay reconstruction for up to 12 months.
If youre advised against reconstruction your surgeon should explain why. You can ask for a second opinion if this would be helpful.
Reconstruction is not commonly offered to men who have a mastectomy for breast cancer, but its possible to improve the appearance and evenness of the chest with surgery.