A breast cancer diagnosis is terrifying and emotionally difficult. However, it is sadly not an uncommon experience. 1 in 8 women will be diagnosed with the disease at some point in their lifetime. Treatment options may include breast cancer surgery to remove one or both of your breasts. This is called a mastectomy and is one of the most effective treatments for breast cancer. However, the loss of a breast can be devastating psychologically, which makes this type of surgery all the more difficult.
Reconstructive breast surgery is an option that helps women move forward from a mastectomy. This procedure uses either your own fat and tissue or breast implants to create a new breast to replace the one that was removed. The surgery will not restore the exact appearance or feel of your original breast tissue, but it does help many women feel more confident and more feminine as they recover from their breast cancer.
Psychological Impact of Reconstructive Surgery
It’s important to consider the psychological impact of breast reconstruction as this type of breast surgery is incredibly difficult for many women. You may wish to consult with a psychologist to discuss your feelings about the procedure. Although the end results help many women, it’s important to understand that the reconstructed tissue will not look the same as your natural breast and will have visible scars. There is also a loss of breast sensation with this type of surgery. You should prepare emotionally for the results of the surgery by working with your medical team and psychologist to set reasonable expectations.
The Process of Breast Reconstruction
Some women choose to get reconstructive surgery at the same time as their mastectomy. In these cases, the breast is removed and new tissue is used to reconstruct it in the same surgery. In other cases, they may wait between the initial procedure and breast reconstruction. This will depend on your specific medical situation and your desires. Dr. Hess and Dr. Sandeen will review your situation along with any other doctors involved in your cancer treatment, and can make a recommendation for you.
There are two main surgical methods for breast reconstruction. Both have benefits and downsides, so it is important to discuss with Dr. Hess and Dr. Sandeen which will be best for your specific situation.
Autologous / “Flap” Reconstructive Surgery
An autologous or “flap” breast reconstruction uses fat and tissue from another part of your body to create a new breast. This may include skin and fat from your belly, thighs, or back. This procedure may be necessary if your masectomy or any radiation treatment you underwent did not leave sufficient tissue on your chest for an implant. In most cases, you can get a flap reconstruction and then use the transplanted tissue to cover and support an implant.
There are a few different techniques for flap reconstruction. A TRAM (transverse rectus abdominis musculocutaneous) flap uses muscle, skin, and fat from your lower abdomen in order to construct a breast mound. This is the only breast reconstruction technique that uses muscle. A SGAP (superior gluteal artery perforator) flap uses fat and skin from your buttocks. Finally, a DIEP (deep inferior epigastric perforator) flap uses tissue from your abdomen.
This type of breast surgery is more intensive than breast implants. The initial recovery time is also longer. However, this method has a lower risk of long-term complications, assuming you do not get an implant as well.
You may also be worried about the symmetry of your breasts following reconstruction if you have only one breast removed during your mastectomy. In some cases, you may consider getting a breast lift, breast augmentation, or breast reduction on the remaining natural breast at the same time as a reconstruction.
Breast implants are filled with silicone, saline, or a combination of the two. They are inserted either behind the skin and fat on your chest or behind the chest muscle. You can choose a size and shape that works best for your preferences and that is closest to your natural breast. This has a lower risk for complications initially compared to a flap reconstruction. However, over time the implant may require additional surgeries and long-term complications are more common. You should work with your plastic surgeons to determine how to best reduce these risks.
Breast Surgery Recovery
Your surgeons will give you specific instructions for steps to take during your recovery. As a general rule, your surgeon will apply gauze or bandages to your incision. You may also need tubes for draining fluids from the new breast during recovery. You will likely need to use an elastic bandage or support bra during the healing process. Make sure you have someone to drive you home from the surgery. It can also be helpful to have someone to help you during recovery, as you will need to reduce your activity to avoid opening up the incision.
Healing from this type of breast surgery takes several weeks. You may experience swelling and pain. If you have shortness of breath, chest pain, or irregular heartbeat, you need to immediately seek emergency medical care. Your surgeon will give you specific signs to look out for during your healing and will be available for follow-ups and to answer any questions.
Breast Reconstruction Cost
In addition to wondering about the recovery and final results of reconstructive breast surgery, you may also be wondering about the cost. Unlike most plastic surgery, breast reconstruction is usually covered by health insurance as it is a reconstructive and not a cosmetic procedure. However, you should check with your provider to learn the specifics of their breast reconstruction coverage.