First and foremost, our health and wellness is always our top priority. Once a surgeon has determined which treatments are most effective in ridding the breast and body of cancer, the first goal is to focus on treating the body and giving it all of the TLC it needs to get better. If your doctor decides a mastectomy is needed, it's then your call on whether you wish to get breast reconstruction — the most common of which involves the placement of a breast implant, says Dr. Maggie DiNome, director of the Margie Petersen Breast Center at John Wayne Cancer Institute at Providence Saint John's Health Center in Santa Monica, California. Another option is flap reconstruction, which involves taking tissue from another part of the body to rebuild the breast.
"A reconstruction can happen any time after a mastectomy, but the best cosmetic outcome is usually obtained when the reconstruction is done at the time of the mastectomy," DiNome says.
If a patient needs a lumpectomy — which is when a doctor removes just a lump in the breast — the timing of the procedure would need to be coordinated with any other treatments needed, specifically radiation, DiNome says. Reconstruction options following a lumpectomy include fat injections, implants for volume loss or reductions.
The most common method for reconstructing a breast following mastectomy is done by utilizing tissue expanders and implants, confirms Jaime S. Schwartz, a board-certified plastic surgeon at Beverly Hills Breast and Body Institute. "Most often, immediate reconstruction with use of either tissue expanders, or direct-to-implant, is a safe and effective option," Schwartz says. "The quality of the remaining skin envelope and adequacy of the blood supply at the time of mastectomy are the largest determining factors for use of direct-to-implant approach versus use of tissue expanders," Schwartz says.
Women who are concerned about achieving results that mimic their original cup size and shape should feel relieved to know that their goals are aligned with those of a credited surgeon. "A woman’s goals for breast reconstruction, original cup size, and chest wall measurements weigh in heavily when determining cup size."
Here's what Schwartz says a woman can typically expect to experience during a breast reconstruction procedure: The surgery is performed in the hospital and includes a one- to two-night hospital stay. The first week is the hardest, he says, but by two weeks, most patients feel good. At four weeks, they feel 100 percent. And by six weeks, they are free to resume all normal activity. Patients will have drains (a tube used to remove pus, blood or other bodily fluids) for about up to two and a half weeks. If tissue expanders were placed, the recovery process is a bit different and includes in-office expansions with a saline solution, which Schwartz says gradually builds the breasts. In these cases, a second surgery will be needed to exchange the tissue expanders for implants — but that surgery is outpatient and often an easier recovery.
For all the moms-to-be or those who have little ones: Breast reconstruction will not affect a woman's ability to nurse, unless she has had a mastectomy, DiNome says.
Of course, money is always a concern — especially for those of us who have spent any time in a hospital and have been hit with an outrageous bill. If you have medical insurance, you should know that breast reconstruction isn't thought of in the same way as, say, elective rhinoplasty — thank goodness. Insurance companies see it as a health surgery. "All breast reconstructive procedures for breast cancer are covered by insurance per federal law," DiNome says. "Even surgery on the opposite breast to achieve symmetry is covered."
No one knows the true cost of breast reconstruction — which wildly varies, depending on factors that include the type of implant used and which hospital contracts with which implant companies. Also, be aware that some plastic surgeons accept insurance, while others do not — and what a procedure actually costs isn't always what is charged.
DiNome adds that it's difficult to sum up everything a patient needs to know about breast reconstruction in a few hundred words because the topic is one she discusses with her patients over a two-hour consultation. With hope, breast reconstruction will help the healing process after breast cancer by allowing women to regain a part of themselves they felt they had lost. With or without the procedure, you are special, beautiful and, most importantly, healthy — and able to enjoy your life.
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