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Breast reconstruction (surgery to rebuild a breast's shape) is often an option after mastectomy. Some health insurance plans pay for all or part of the cost of breast reconstruction and, also, for surgery to the other breast so that both breasts are about the same shape and size.

Reconstruction will not give you back your breast. Although the reconstructed breast will not have natural sensation, the surgery can give you a result that looks like a breast. If you are thinking about reconstruction, you should talk with a plastic surgeon before your mastectomy. Ask your surgeon for a referral to an experienced plastic surgeon. Some women begin reconstruction at the same time as the mastectomy is done; others wait several months or even years.

Breast Implants

A plastic surgeon is able to form a breast mound by using an implant or by using tissues from another part of your body. Breast implants are silicone sacs filled with saline (salt water) or silicone gel. The sacs are placed under your skin behind your chest muscle. Your body type, age, and cancer treatment will determine which type of reconstruction will give you the best result.

SALINE AND SILICONE IMPLANTS
Saline-filled breast implants are available for anyone who wants them. Some scientists are concerned about possible short-term and long-term health problems associated with silicone gel-filled breast implants. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in an FDA-approved clinical trial. Your surgeon can determine if you are eligible and can make arrangements for you to join the study.

POSSIBLE PROBLEMS: As with any surgery, you may have some pain, swelling, bruising, and tenderness. These problems should disappear as you recover. Scars will fade over time. You should let your doctor know immediately about any fever, infection, or bleeding. Side effects that could appear later include rupture, leakage, deflation or shifting of the implant, or interference with mammography readings. Breast implants age over time and may need to be replaced.

RECONSTRUCTION WITH TISSUE FLAPS
A flap (section)
of skin, muscle, and fat can be moved from another part of the body to the chest area where it is formed to create a breast shape. This tissue can be taken from the lower abdomen, back or buttocks.

Tissue Flap Reconstruction: This flap of skin, muscle, and fat is moved while still connected to its blood supply. It is then shaped to form a new breast mound. Choose a plastic surgeon who has been trained in this procedure and has performed it successfully on many women. Of course, you will need to have regularly scheduled followup care and mammograms.

POSSIBLE PROBLEMS: Tissue flap reconstruction is a major operation, resulting in large surgical wounds. If there is a poor blood supply to the flap tissue, part or all of the tissue in the breast area may not survive the transplant. Infection and poor wound healing are possible problems.

WHAT YOU SHOULD KNOW

Most women who have breast reconstruction are happy with their decisions. A woman starting this process, however, should know that breast reconstruction requires more than one surgery.

Extra steps may include:

• Adding a nipple.
• Changing the shape or size of the reconstructed breast.
• Surgery on the opposite breast to create a good match.

With most of these extra surgeries, you can go home the same day as the operation.

QUESTIONS TO ASK YOUR PLASTIC SURGEON

• What is the latest information about the safety of breast implants?
• How many breast reconstructions have you done?
• Which type of surgery would give me the best results?
• How long will the surgery take? What kind of anesthesia?
• When do you recommend I begin breast reconstruction?
• How many surgeries will I need?
• What are the risks at the time of surgery? Later?
• Will there be scars? Where? How large?
• Will flap surgery cause any permanent changes where tissue was removed?
• What complications should I report to you?
• How long will my recovery take? When can I return to my normal activities?
• What activities should I avoid?
• Will I need followup care?
• How much will it cost?
• Will my health insurance pay for breast reconstruction?