As a plastic surgeon, I specialize in performing breast reconstructions for women with breast cancer who have undergone mastectomy or lumpectomy, meaning the breast has been fully or partially removed in order to extract the cancer. Making the decision to undergo breast reconstruction is a very personal one, and there are a lot of factors to consider. Here’s what I want my patients considering breast reconstruction to know.
Many women with breast cancer are not aware that their health insurance very likely covers breast reconstruction at any time post-mastectomy or post-lumpectomy. The Women’s Health and Cancer Rights Act of 1998 requires that all group health plans that pay for mastectomy must also cover reconstructive procedures and prostheses. Medicare covers breast reconstruction as well, although Medicaid coverage varies by state. That doesn’t mean getting coverage isn’t sometimes a process; it can sometimes take a lot of pre-authorization work on the part of the surgeon and the patient, but it’s well worth the effort. At times, people opt not to undergo breast reconstruction because they aren’t aware their insurance will cover it, so it’s important to know coverage may not be an obstacle after all.
There are two options for rebuilding the breast: we can use an implant or we can use your body’s own tissue, which is known as flap reconstruction.
Implants
Implants are made from either silicone or saline, and there are pros and cons to each type. They’re much safer than they were in the past, and often they are the right option for women who, among other reasons, don’t want to undergo an additional procedure to remove tissue from another area of their body. Building the breast using an implant is fairly straightforward; the surgery is a few hours, and many women stay in the hospital for just one night, sometimes two.
Occasionally, people go home the same day, equipped with drains to remove fluid. You’ll come back to see your physician within a few days to take out some of the drains and make sure everything is healing appropriately. It’s less physical recovery, although you do need to follow up with your surgeon every few years to ensure the implants have not ruptured.
Flap reconstruction
Flap reconstruction uses your own body’s tissue to recreate the breast. Your surgeon will remove tissue, typically from your abdomen, thighs, or buttocks, which can add a few more hours to the length of the surgery. The surgery is quite involved because we’re removing microscopic veins and arteries along with the tissue from your abdomen. We collect skin, fat, an artery and vein that feeds the skin, and sometimes part of the sit-up muscle. Then, we start to rebuild the breast: we connect the artery and vein to an artery and vein in your chest.
You’ll typically stay in the hospital for a few days because it’s a longer surgery, and we want to make sure the transplanted tissue is taking. You’ll feel a bit more sore because you’ve had surgery on two different parts of your body, so your recovery will be longer. Many people are unable to return to their regular activities of daily living for about a month; you’re sore, tired, and it’s hard to build up stamina. However, after you’ve recovered, you don’t have to worry about replacing an implant or monitoring for a rupture. And it’s your tissue forever – if you gain weight, it grows with you. If you lose weight, it deflates with you. It’s yours.
There are pros and cons to both techniques, so make sure you discuss any questions with your doctor and ensure your concerns are addressed.
Any surgery requires a recovery period, and breast reconstruction is no different. It’s really hard to undergo any surgery without support, and I want patients to keep in mind that breast reconstruction is not just a physical recovery – it’s an emotional one, too. Many of my patients’ relationships with their bodies have changed after their breast cancer diagnosis. Removing and rebuilding the breast brings even more to process. This experience can really shake your faith in life to the core. We call it the emotional recovery rollercoaster: some days you have a little bit of energy, and some days you’re down and can’t get out of bed. That’s all normal, and it’s essential to have a champion at your side reminding you to give yourself a break, to take it one day at a time, and to keep in mind that everyone recovers at a different rate.
Make sure to lean on a support system, whether you turn to a spouse, parent, close friend, or another loved one. Connecting with other people who have undergone mastectomies and breast reconstruction is also an incredible resource. There are organizations facilitating these connections, and your doctor can help point you in the right direction. Women who have stood in your shoes are a powerful force, full of tips about managing the emotional challenges as well as practical advice about which drain holder they prefer or which soft camisole was their favorite.
Your doctor can also connect you with a cancer navigator, whose job is to guide you through this process. Don’t be afraid to voice your concerns with your doctor as well as your cancer navigator – use them as a source of support, as well. Our goal as physicians is to keep you healthy; that means removing cancer from your body, but that also means caring for your emotional well-being. You’re an important person who needs to move on with your life without cancer involved, and you’ve got a community behind you ready to help get you there.
