Nov 14, 2019
Note: The following article originally appeared in Minnesota Spokesman-Recorder.
by Valerie Lemaine, MD, MPH, FACS
October is National Breast Cancer Awareness Month. Did you know that breast cancer is one of the most common kinds of cancer in women? Today, about one in eight women born in the United States will get breast cancer at some point in their lifetime. The good news is that if the cancer is found and treated early, most women can survive breast cancer.
But did you know that for women who need a mastectomy, breast reconstruction is an option that is covered by your health insurance provider? In the United States, there are two laws you should know about that protect you if you are considering breast reconstruction after mastectomy:
- Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law in 1998. It requires most group health insurance plans that cover mastectomies to also cover breast reconstruction.
- Breast Cancer Patient Education Act (BCPEA) was signed in 2015. This law requires that if you are diagnosed with breast cancer, you should be informed about the availability of breast reconstruction and breast prostheses.
Breast reconstruction options
Breast reconstruction is serious surgery to rebuild your breast(s), and it should only be considered with a skilled, board-certified plastic surgeon. You need to find a plastic surgeon who makes you comfortable, who listens to you and explains the surgery in ways you can understand.
It is your right to make an appointment with another plastic surgeon to get a second opinion if you aren’t comfortable with the first one you meet. Reconstruction usually involves more than one surgery, so you want to choose a plastic surgeon you really get along with!
When is breast reconstruction done?
Breast reconstruction can be done at the same time as the mastectomy (we call this “immediate reconstruction”), or in a separate surgery done several months or even years after the mastectomy (we call this “delayed reconstruction”).
Types of breast reconstruction
There are two types of breast reconstruction surgeries you need to know about:
- Breast reconstruction using breast implants
- Breast reconstruction using your own tissue (also known as “autologous breast reconstruction” or “tissue flap reconstruction”)
Breast reconstruction with implants
If you choose implant reconstruction, your plastic surgeon may use a temporary device called a tissue expander at your first surgery. The tissue expander is used to create a breast shape under your skin or under your chest muscle, where the future permanent breast implant will go. Sometimes, the permanent breast implant can be placed at the first surgery, which means that your reconstruction can be completed in one step.
Breast reconstruction with implants usually requires less surgery than if you choose the tissue flap. The length of surgery and the amount of time you need to recover are also usually shorter with breast implants than with a tissue flap reconstruction.
Still, you may require more than one operation to build your breast(s) with implants. Also, keep in mind that you may need more surgery in the future to change your breast implants because they don’t last a lifetime.
Breast reconstruction using your own tissue
If you have a tissue flap reconstruction (also called “autologous reconstruction”), your plastic surgeon will take tissue (skin, fat and sometimes muscle) from one part of your body to build a breast shape. Most of the time, the tissue is borrowed from your belly, but it can also be taken from your buttocks, your inner thighs or your back.
Tissue flap reconstruction can be done in two ways: Sometimes, the tissue will be completely detached from your body and placed on your chest. We call this a “free flap.” Your plastic surgeon may choose to leave the tissue flap attached to your body and move it under your skin to your chest. We call this a “pedicled flap.”
To do a free flap reconstruction, your plastic surgeon needs to have trained in microsurgery, which is a specialized skill that not all plastic surgeons have. With microsurgery, your plastic surgeon will reconnect the blood vessels from the tissue flap that was detached from your body to blood vessels in your chest area, so that the tissue flap can receive blood flow and stay alive.
Because those blood vessels are pretty small, your plastic surgeon will use a microscope to reconnect the blood vessels, hence the name “microsurgery.” Because of this, free flaps are a longer and more complex surgery than pedicled flaps.
Breast reconstruction using your own tissue has one major advantage over breast implants: It usually lasts a lifetime. Also, it feels more natural than breast implants because the tissue flap is mostly made of fat, just like our breasts.
Related story: Breast reduction surgery: for some, it’s a good option with exceptional results
It is important to know that flap reconstruction involves a longer surgery, and also a longer recovery, because you are healing more than one body part at the same time: Your breast needs to heal, but so does the area where the tissue was borrowed from. Because of this, tissue flaps are not a suitable option for everyone
It’s a personal decision
Whether you were diagnosed with breast cancer, or if you are at very high risk of developing it in the future (remember Angelina Jolie’s story?), if you need a mastectomy, breast reconstruction surgery may be an option for you. Keep in mind that no matter which type of breast reconstruction you choose, there is no “one and done” option.
Rebuilding a breast often requires more than one surgery. Also, in the future your breast reconstruction may need adjustments because our bodies change over time.
Women who have had breast reconstruction report improved self-esteem and body image. Having said that, some women choose not to have breast reconstruction because they don’t want to have additional surgery.
The decision to reconstruct or not is very personal. You can’t predict how you will feel after losing a breast. Some women feel sad and anxious, while others don’t.
Talk to your doctor and request a consultation with a board-certified plastic surgeon. Many of my patients have told me that having breast reconstruction was one of their best decisions.
Dr. Valerie Lemaine, M.D., M.P.H., is a board-certified plastic surgeon in private practice in Edina, MN. She received her M.D. from University of Montreal, Canada, and her M.P.H. from Columbia University, NY, USA. She also completed a reconstructive microsurgical fellowship at Memorial Sloan-Kettering Cancer Center in New York City. Dr. Lemaine then accepted a staff position at the prestigious Mayo Clinic where she taught, practiced and published clinical research until 2018.