Breast reconstruction is performed by a plastic surgeon who is usually highly trained in advanced microsurgery. Reconstruction may happen at the same time as a lumpectomy or mastectomy (immediate reconstruction), or it can occur as one or more separate procedures at a later date (delayed reconstruction).
The decision to have breast reconstruction is very personal, and may not be right for every woman. Many women find that restoring the breast helps them feel complete and whole again, lessening the psychological and emotional impact of a mastectomy or lumpectomy. Other women opt not to reconstruct their breasts, choosing to “go flat” instead.
We’re here to offer guidance and education about the available options so that you can make an informed and empowered decision about breast reconstruction.
To learn more about the breast reconstruction process, see What to Expect from Diagnosis to Recovery.
The most common approaches to breast reconstruction are implant reconstruction and natural tissue reconstruction (also known as flap reconstruction). Hybrid reconstruction, which combines both implant and tissue flap methods, may be used in some cases. Finally, partial breast reconstruction is an alternative for women who have had a lumpectomy.
This type of breast reconstruction uses tissue from your own body to form the new breast. A flap of tissue is taken from one part of your body, along with its blood supply. That helps the tissue flap survive in a new location and allows it to be used for reconstruction. Tissue flap procedures typically either leave the tissue partially attached, or they detach and then reconnect small blood vessels to restore circulation. The surgeons at the Friedman Center specialize in the DIEP flap procedure which is considered to be the gold standard of natural tissue breast reconstruction.
In this type of reconstruction, a synthetic implant containing saline solution or silicone gel is surgically inserted to form the shape of the new breast. Implants come in many different shapes and sizes, and they are a very common method of restoring the breast after breast cancer. This technique may use an adjustable temporary implant prior to placing the final implant. This allows for proper healing and helps patients choose the best size long term.
Hybrid reconstruction uses both tissue from your own body and a synthetic implant to rebuild the breast. The hybrid approach may be a viable option for women who may not see optimal results from flap or implant reconstruction alone.
Partial reconstruction recreates symmetry in the breasts after a partial mastectomy, also known as a lumpectomy. There are several possible approaches to this type of reconstruction, including breast lifts or reductions, tissue transfer, fat grafting, or implants.
If you are having a single mastectomy, you may also wish to have cosmetic surgery on the opposite breast to help restore symmetry. These cosmetic procedures include breast lift, breast reduction, and breast augmentation. If multiple procedures are involved, breast reconstruction may be done in stages.
There are a number of advantages to immediate breast reconstruction:
There can be a number of reasons for delaying reconstructive surgery:
There are some disadvantages to delayed reconstruction as well:
Will my oncologist be able to detect breast cancer recurrence after having breast reconstruction?
Fortunately, in the vast majority of cases, the answer is yes. The majority of recurrences are just beneath the skin and therefore are palpable and tend to be found in imaging as part of routine ongoing cancer screening.
Does breast reconstruction make breast cancer recurrence more likely?
Studies have shown that reconstruction does not increase the chances that breast cancer will come back. Though certain types of textured breast implants are linked to a rare type of cancer called anaplastic large cell lymphoma (ALCL), our surgeons no longer use this type of implant.
Is breast reconstruction covered by insurance?
Under the Women’s Health and Cancer Rights Act of 1998 (WHCRA), insurance companies are required to pay for breast reconstruction after a mastectomy or lumpectomy. The WHCRA also includes surgery of the unaffected breast to achieve balance and symmetry. The WHCRA covers implant-based reconstruction as well as natural tissue reconstruction, and it is not affected by the timing of your reconstruction, whether immediate or delayed. Learn more about insurance coverage for breast reconstruction.