Medically reviewed by Dominic Heffel, MD McLeod Plastic & Reconstructive Surgery
When actress Angelina Jolie had her highly publicized mastectomy, she had breast reconstruction surgery at the same time. The decision to have breast reconstruction is becoming a more common decision among the 296,000 women annually who face breast cancer.
“The patient faces a whole range of options,” says McLeod Plastic and Reconstructive Surgeon Dominic Heffel. “The simplest is to do nothing. They can do something that uses an implant or we can use some of their own tissue to rebuild the breast.”
WHEN IS THE BEST TIME FOR RECONSTRUCTION?
Interviews with more than 100,000 breast cancer patients revealed that reconstruction immediately after mastectomy improves a woman’s psychological well-being and quality of life. Women also report improved body image and self-esteem, compared with delaying the procedure.
Immediate reconstruction is started at the same time as the cancer surgery. Both a breast surgeon and a plastic surgeon are normally involved. This is the most common reconstruction performed today.
Delayed reconstruction is normally best if a woman is scheduled for radiation therapy following surgery. The radiation can damage tissue used to rebuild the breast.
HOW WILL THE DOCTOR RECREATE MY BREASTS?
Prosthetic reconstruction uses artificial implants. Usually the implants are inserted under the skin and are slowly enlarged over several weeks to allow the skin to gradually stretch to the appropriate size.
The most common implant in reconstruction is filled with silicone gel. The new silicone gels have alleviated concerns about leakage. The gel has been modified to be more cohesive and behave more like a soft solid. Surgeons sometimes call them “gummy bear” implants. Prosthetics are a good option, if you keep in mind that they don’t last a lifetime. Half of implants used for breast reconstruction have to be removed, modified or replaced in the first 10 years.
Flap surgery, also called “autogenous”,uses your own tissue to rebuild the breast. Tissue flaps can be taken from the abdomen as well as from the thigh, back or buttocks. This is major surgery: removing skin, muscle and blood vessels from one part of your body and stitching it to another. The abdominal scar is similar to a tummy tuck, kept below the top of the underwear line. The back scar can be hidden in the brassiere line with proper planning.
Scars from flap surgery will fade over time but never disappear. Every woman with breast cancer should be seen for reconstruction by a Plastic and Reconstructive Surgeon. Her health status and behaviors, such as smoking, will play a role in her options. However, with proper design and the appropriate discussions, even diabetics and smokers can possibly undergo state of the art microsurgical reconstruction.
WILL MY INSURANCE PAY?
Probably. As a result of the 1999 Women’s Health & Cancer Rights Act, commercial and employer-provided insurance is required to pay for reconstructive surgery when a woman has a mastectomy. If you have questions, check with your health insurer.
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Sources include: McLeod Health, American Cancer Society, National Cancer Institute, American Association for Cancer Research, National Health Service, PinkHope.org.au