About Procedure
Before & After
« Breast Reconstruction
« Surgical Procedures



Is a breast reconstruction right for me?
Almost every woman who has lost a breast to cancer can have her body restored with breast reconstruction. However, the following conditions are desirable:
•  You clearly understand that although your figure will be markedly improved, your reconstructed
   breast will not look or feel exactly the same as the breast that was removed.
•  Your oncologist has advised you that reconstruction is appropriate for you with regard to your stage
   of cancer or treatment. (Should cancer recur, your reconstructed breast will not interfere with further
   treatment. However, such treatment may affect the appearance of your reconstructed breast.)
•  You feel that you are able to handle the period of emotional adjustment that may accompany breast
   reconstruction. Just as it takes time to get used to the loss of a breast, it may take some time
   before you begin to think of the reconstructed breast as your own.
•  You have no additional health concerns that may complicate the procedure, such as
   obesity or heart disease.



What should I expect from the consultation?
A personal consultation is the first step for every patient considering breast reconstruction. During this meeting, your surgeon will assess your physical and emotional health and discuss your specific goals for the procedure. You should arrive at the consultation prepared to provide complete information about:
•  Previous surgical procedures
•  Past and present medical conditions
•  Medications you are taking, including dietary or herbal supplements
•  Past experience with weight loss and the effect it had on your breast size

To help you determine which reconstruction method will give you the best results, your surgeon will perform a physical exam. Measurements and photographs may be taken for your medical record.

Thanks to the advocacy efforts of the American Society of Plastic Surgeons (ASPS) and several breast cancer support groups, insurance companies are now required by law to cover the cost of reconstructive surgery for women who have undergone a mastectomy. The law also requires coverage for procedures to restore and achieve symmetry on the opposite breast.

Because regulations related to the law are not yet final, coverage denials still occur. It’s best to let your plastic surgeon know if you are having difficulty getting coverage. Many insurance companies require a letter of predetermination. Your surgeon’s office staff will help you with this and any other insurance matters related to the procedure.



How is breast reconstruction performed?
There are many options available in breast reconstruction. Your anatomy, your surgeon’s preferences and your desired results will help determine which method is best for you.

Skin expansion with a breast implant. This is the most common method of reconstructing a breast. Following mastectomy, a balloon expander is inserted beneath the skin and chest muscle. Over several weeks, the expander balloon is gradually filled with a salt-water solution in the doctor’s office, causing the overlying skin to stretch. When the skin has stretched sufficiently, the expander is surgically replaced with a more permanent implant. Some expanders are designed to be left in place as the final implant. The nipple and the skin surrounding it, called the areola, are reconstructed in a later procedure.

In rare cases, when a sufficient amount of skin is available, an implant can be placed without the preliminary skin-expansion step.

Flap reconstruction. Although flap reconstruction is more involved at the initial procedure than reconstruction with an implant, many women prefer it because it may allow the breast to be rebuilt with natural tissue. Also, unlike the tissueexpander method, the breast mound is completed at the initial operation, without the need for expansion over an extended time period.

In one method, the breast is reconstructed using a tissue flap – consisting of a portion of skin, fat and muscle – that is taken from the back, or abdomen. The flap, still tethered to its original blood supply, is tunneled beneath the skin to the front of the chest wall. The transported tissue may be bulky enough to create a new breast mound itself. However, sometimes an implant will be inserted as well.

In a more complex flap technique, tissue that is removed from the abdomen is surgically transplanted to the chest by reconnecting the flap’s blood vessels to vessels in the chest region. Although more complicated, this microsurgical reconstruction may provide a more natural and less traumatic reconstruction in many women.

Although recovery from flap reconstruction may take longer than with implant reconstruction at the initial procedure, it does not require a secondary procedure for placing a permanent implant, nor does it require the weekly office visits needed for tissue expansion. Additionally, a flap procedure may improve the contour of the site from which the borrowed tissue was taken. For example, a protruding abdomen may appear trimmer after tissue is taken from the area and used to rebuild the breast.

All of these procedures have advantages and disadvantages, and many times the choice of procedures is limited by other health factors, such as weight, other medical conditions and previous cancer therapy. Your plastic surgeon will help you to determine which is the best procedure for you.

Follow-up procedures. Once the breast mound is restored in the initial procedure, one or more follow-up procedures will be performed to replace a tissue expander with a permanent implant or to reconstruct the nipple and areola. Your surgeon may also recommend an additional operation to lift or reduce the opposite breast to match the appearance of the reconstructed breast.



What are the risks associated with breast reconstruction?
Each year, thousands of women undergo breast reconstruction and experience no major complications. However, one of the most important parts of your consultation with your plastic surgeon is discussing the risks as well as the potential benefits of surgery. Certain complications are possible in any type of surgery including; blood loss, infection and others. Your specific risk should be discussed with your surgeon.

Potential complications specific to breast reconstruction vary with the type of reconstruction you and your surgeon choose. For instance, with flap reconstruction, there is a small risk of partial or, very rarely, complete flap loss. Reconstruction with an implant has the potential for breast firmness (capsular contracture) and implant rupture. The probability of having one of these or other complications must be thoroughly discussed with your surgeon.

Remember, by carefully following your surgeon’s advice and instructions – both before and after surgery – you can do your part to minimize some of the risks.