Reconstruction: Yes or No?

Some women prefer not to undergo any additional surgical procedures beyond mastectomy. Others feel strongly that they do not want to wake up from surgery without new breasts to replace the originals. Many may not be sure how they feel and prefer putting off the decision until after they have undergone mastectomy and additional treatments.

 We’re fortunate to live in a time when any of these positions can be accommodated by a variety of surgical techniques. Few decisions are irreversible, no matter how much time passes, how your feelings change over time, or even if you choose one form of reconstruction and later decide you would prefer another.

 You are a potential candidate for breast reconstruction no matter what your age, your body type, if you had your mastectomy years ago, have had chest radiation, have other medical conditions, such a diabetes, or even smoke (though you will be asked to quit).

 For many women, breasts are an intrinsic part of their self-image and sexual identity. Having both breasts may be very important to your present intimate life or future relationships. Studies show improved mental health after breast reconstruction and even a correlation with lower rates of cancer recurrence.

 Some women factor their age into their decision, and studies indicate that some doctors do as well, with women over forty less likely to be referred to a reconstructive surgeon by their doctor than younger women. But for many women, age is irrelevant. Women older than 70 and even 80 have had successful breast reconstruction. In any case, whether or not to restore a breast lost to cancer, as well as which reconstructive method to use, is not your doctor’s decision to make for you. Women have a right to all of the information they need to make their own decision.

 Immediate or Delayed Reconstruction?

 It is now possible to have breast reconstruction during the same surgery as mastectomy. So if you’re lucky, you need never wake up without breasts. This requires that your reconstructive surgeon work in coordination with your breast surgeon. Your reconstructive surgeon will be present at the time of mastectomy and may make recommendations about the placement of incisions so as to produce minimal scarring on the reconstructed breast. When the mastectomy portion of the surgery is complete, the reconstructive surgeon takes over.

 A big advantage of this collaborative approach is the possibility of preserving all of your breast skin envelope (including your nipple, in some cases). It also saves you from undergoing a separate surgery for the first phase of breast reconstruction. Most all reconstructive techniques will likely involve at least one more surgery for the best cosmetic results, in addition to this first phase. Generally, there will be one (or two – in the case of implants) surgery to establish the new breast mound; and another, if necessary, to fine-tune the shape, address symmetry issues, and build a nipple, if desired/needed.

 There are many reasons why you may be looking at delayed reconstruction. But be assured that you can still obtain excellent reconstruction results: 

  • ·Perhaps you’ve already had your mastectomy. It doesn’t matter how long ago that surgery took place — it could even be decades — you are still a candidate for breast reconstruction.
  • ·Maybe you just aren’t ready to decide what, if any, breast reconstruction you desire, but want to go ahead with the mastectomy and figure out the rest later.
  • ·You may have a health condition that could interfere with healing, and your doctor is advising you delay reconstruction. Maybe you’re having chemotherapy first, and you develop complications or your immune system needs time to recover before you undergo additional surgery.
  • ·If you decide you want implant reconstruction, but need to undergo radiation therapy, you must consider that implants and radiation do not always mix well, neither before nor after treatment.
  • ·Perhaps you’ve already had breast reconstruction, but you are dissatisfied with the results and want to try a different technique.

 Will Insurance Cover Reconstruction?

 Too many women are unaware that health insurance must cover breast reconstruction. They mistakenly believe this surgery is cosmetic and they would have to assume all costs. Recognizing that breast reconstruction following mastectomy is a medical necessity, rather than merely elective, Congress passed the Women’s Health and Cancer Rights Act of 1998. It states that if you have health insurance that covers mastectomy, breast reconstruction and surgery to attain symmetry shall be covered as well. If you are uninsured, reconstruction benefits vary by state.