How much does breast reconstruction cost after mastectomy?

I would like to have breast reconstruction after my surgery for breast cancer. Can this be done?

You should ask your surgeon for a consultation with a plastic surgeon before the mastectomy if possible. Depending on the individual, breast reconstruction is available to women who have had either a single or a double mastectomy. The results and the difficulty of the operation will vary with each individual case. Many women having mastectomies may be candidates for breast reconstruction ifthey and their surgeons know the facts about current techniques. In many cases, if arrangements are made before the operation, the plastic surgeon can be in the operating room at the time of the mastectomy.

Questions to Ask Your Plastic Surgeon Before Breast Reconstruction


• What type of surgery do you recommend for me? Why?

• What are the risks and benefits associated with it?

• What is your experience with this operation?

• Do you have any before and after pictures you can show me?

• May I talk with someone who has had the operation?

• What can I expect my new breast to look like? What will it feel like? Will it change in time?

Will the breast look as it did before the mastectomy?

You should not expect that it will. The new breast will probably look more flattened than tapered. It may not droop as much as your natural breast and may not match it. Under clothing, you can probably not notice the difference, and most patients are pleased with the results of the reconstruction. They say it makes them feel more like their old selves. Although the new breast will not be a perfect replica of the old one, most women who have the reconstruction surgery can wear a normal bra or a bikini. The plastic surgeon will talk to you about your expectations. If they are not realistic, he may suggest that you not have the reconstruction.

What is involved in breast reconstruction?

Breast reconstruction means a second operation, and sometimes even two or more additional operations. The plastic surgeon implants a silicone rubber envelope (usually a halfmoon of silicone gel which has been specially molded) under the skin. Unlike silicone injections which have been used to enlarge breasts (and are now banned in many states), the silicone implant appears to be entirely safe. This implant forms a breast mound.

Are there different types of surgery performed for breast reconstruction?


There are three types of surgery:

• Simple breast reconstruction

• Latissimus dorsi reconstruction

• Rectus abdominus reconstruction

What does simple breast reconstruction entail?

The surgeon makes a small incision along the lower part of the breast area, near the mastectomy scar, and puts the implant into a pocket created under the chest muscle. A drain may be put in to take away the fluid that may accumulate during the next few days, and then the incision is closed. The operation takes about 1 to 2 hours and is usually done under general anesthesia. Sometimes this operation is done as outpatient surgery.

What is latissimus dorsi reconstruction?

This operation is used when chest muscles have been removed and where there is too little skin to hold and cover an implant. The surgeon transfers skin, muscle, and other tissue from the back to the mastectomy site. To create a new muscle on the front of the chest, a broad flat muscle on the back below the shoulder blade called the latissimus dorsi is used. An implant is then placed under the new chest muscle. Drains may be put in and kept in place for several days after the surgery to remove fluid. This operation takes several hours, and patients stay in the hospital for about a week. You will have a scar on your back as well as on your chest.

What is rectus abdominus reconstruction?

This operation is also used when a lot of skin and muscle have been removed. The surgeon transfers one of the two abdominal muscles the rectus abdominus to the breast along with skin and fat from the abdomen. This flap of muscle, skin, and fat is shaped into the contour of a breast. If there is enough abdominal tissue available, no implant is needed. Transferring tissue in this way also results in tightening of the stomach, called a tummy tuck. You will have a horizontal scar across the lower abdomen plus the scar on your chest.

Will I be able to have a nipple as part of breast reconstruction?

If you wish to have one, it is usually possible. However, construction of the nipple and areola (the circle of dark colored skin surrounding the nipple) may require another operation, usually lasting 1 or 2 hours.

How is the nipple reconstructed?

The nipple is usually reconstructed using tissue from the newly created mound or by grafting a piece from the opposite nipple. The areola is made by using skin from the upper inner thigh or skin from behind the ear. Skin from the vaginal lips can also be used to reconstruct the nipple and areola. If the reconstructed areola is not dark enough, ultraviolet light may be used to improve the color match.

Is it true that reconstruction can hide new cancer?

No. Doctors believe there is little or no difficulty in promptly finding a recurrence of cancer, either beneath or around an implant, using examination by hand or mammography. If cancer were to recur in the reconstructed breast, it would most likely be located just under the skin and easy to find.

When can breast reconstruction surgery be done?

It depends upon the kind of operation you have had, the extent of your cancer and the wishes of your plastic surgeon. If you have had a simple or modified radical mastectomy, you will probably have to wait for 3 to 6 months until the scar has healed, although some doctors say that patients with minimal disease can have reconstruction immediately following cancer surgery. In several major centers, breast reconstruction, including implanting the soft plastic artificial breast and reconstruction of the nipple, is being done at the same time as the mastectomy. If you are having chemotherapy or radiation treatments, most doctors prefer to wait until you have completed them. Most doctors wait another 3 months between the operation which creates the breast mound and the construction of the nipple.

I had my mastectomy more than 10 years ago. Can I still have breast reconstruction?

There are women who have had successful reconstructions with mastectomies over 20 years old. The fact that you had a mastectomy many years ago does not disqualify you as a candidate for the operation. Nor does your age.

I have had radiation treatments. Can I still have a breast reconstruction operation?

Probably. Almost any woman who has had a mastectomy for breast cancer can have her breast reconstructed. Radiation damaged skin, grafted, thin, or tight skin or the absence of chest muscles are no longer obstacles to breast reconstruction.

My remaining breast is large. Can I have the reconstruction operation?

Yes. However, there is a limit to the size of the reconstructed breast. The limit is based on what the skin can support. Usually the surgeon will reduce the size of the remaining breast so that it will more nearly match the new breast. This operation may be done at the time of reconstruction or as a second operation. The operation to reduce the size of the remaining breast is called reduction mammoplasty.

Are there any complications from the surgery for breast reconstruction?

You must remember that there is always the possibility of complications from any surgery, even with the best surgeon. Sometimes, the body creates a firm, fibrous capsule around the implant to protect itself; this may be improved by the surgeon without an operation or may need to be surgically fixed. If an infection occurs at the breast site, the implant may need to be removed until the infection heals and then replaced. Sometimes the implant is temporarily removed if large areas of skin die. Part or all of a transferred muscle may fail to survive. You should also be aware that mastectomy and reconstruction scars are permanent, although the degree of scarring varies among individuals. You should not expect that reconstruction will restore the sensation lost through mastectomy. Discuss possible complications with your plastic surgeon before the operation, realizing that as with any type of plastic surgery, it is difficult to predict the overall results.

Will I have to do anything to my breast after reconstruction?

If an implant is used, after the operation you will be taught how to massage and exercise the muscles surrounding your implant. It will take a few months for the skin and muscle to stretch and for the reconstructed breast to take on a natural appearance.

How long is the recovery period?

It depends upon what operation you have had. Most women are able to resume normal activities in 2 to 3 weeks, although it is usually several more weeks before you can do strenuous exercises.

Do I need to do breast self examination after I have had reconstruction?

Yes. Breast reconstruction does not cause cancer to come back, nor does it prevent recurrence. After reconstruction you will continue to have periodic examinations. In addition, you should examine both of your breasts monthly, following your doctor's instructions.

What if my doctor does not think I should have breast reconstruction?

This depends upon his reasons. If his decision is based on health reasons, you should probably abide by his judgment. However, you could ask to have his reasoning confirmed by a second opinion. If he simply has given you the feeling that breast reconstruction for cosmetic reasons is frivolous or unnecessary, and you would like to have breast reconstruction, you should arrange to talk with a plastic surgeon about your case.

Breast Reconstruction Surgery: Understanding Breast Cancer

Link

What kind of doctor should perform the plastic surgery?

A board certified plastic surgeon should do the breast reconstruction. Be sure that he is experienced with the operation. Ask him how many he does and what his results have been. Most doctors have before and after pictures they can show you. Ask your doctor to recommend someone for the consultation or call a teaching hospital in your community. There is also a society of reconstructive surgeons: American Society of Plastic and Reconstructive Surgeons, Suite 1900, 233 N. Michigan Ave. Chicago, IL 60601, or call its 24-hour patient referral service (312-856-1834).

Breast Reconstruction Surgery

Link

Is it possible for me to talk with someone else who has had the operation?

You should ask your surgeon or plastic surgeon if he will allow you to talk with some of his patients. In addition, local units of the American Cancer Society may help introduce you to women who can describe their personal experiences. The organization RENU (Reconstruction Education for National Understanding) offers up to date information and support. There are active RENU programs in Philadelphia, Cleveland, and Washington, D.C.

How much does breast reconstruction cost?

The operations are expensive and depend upon the extent of the surgery as well as other factors. The surgeon's fee can run from $2,500 to over $14,000, with hospital costs ranging from $2,000 to $6,000. Almost all of the Blue Cross/Blue Shield plans and many of the private insurance plans now cover postmastectomy surgery. Some only cover the hospital costs, while others will also pay part or all of the plastic surgeon's cost. Be sure to know the cost and what your policy will cover before deciding on the operation.

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