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Breast Reconstruction After Surgery


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In general: Breast reconstruction is a procedure performed by a plastic which the shape of the breast is rebuilt after a  mastectomy.

Most women who have breast reconstruction also have the nipple and areola (the darker area surrounding the nipple) reconstructed. The result is that the new breast looks as normal as possible.The procedure involves skin grafts from other parts of the body to reconstruct the nipple. The grafts can be tattooed to match the color of the patient’s own areola.This procedure is usually done a few months after the breast reconstruction.

 Breast reconstruction can either start at the time of the mastectomy or at a later time.

After breast reconstruction, a woman's silhouette can look just like it did before surgery. A reconstructed breast may not look exactly like a natural breast when you are naked. If the nipple and areola are removed, there may be a lack of sensation unless nerves can be repaired.

Women choose breast reconstruction for a variety of reasons. Common reasons include the following: 

  • To make breasts look balanced when wearing a bra.
  • To permanently regain a breast shape.
  • To avoid having to use a form that fits inside the bra (an external prosthesis) to make the breasts appear balanced in clothes.
  • Emotional well being.

There are two types of surgery for breast reconstruction: breast implants and tissue flap. There can also be a combination of the two. Breast reconstruction may require additional surgery to reduce or lift the healthy breast to achieve symmetry between both breasts. It may also require additional surgery to reconstruct the nipple and areola 

Paying for reconstruction: If your insurance covers a mastectomy, it likely covers reconstruction. In fact, the federal Women's Health and Cancer Rights Act (WHCRA) requires all health insurance providers and HMOs that pay for mastectomy to also cover certain services related to breast reconstruction after the procedure. Many states have similar laws. To check the law in your state, contact your state insurance department. You can find contact information at: offsite link.

 If your health insurance covers a mastectomy, it generally covers breast reconstruction.

Before agreeing to reconstruction, it is advisable to:

  • Choose a board certified plastic surgeon who has a great deal of recent experience doing the kind of reconstruction you are considering.
  • Ask the plastic surgeon all the questions that come to mind.
  • Talk with women who have had this surgery. Consider asking:
    • How satisfied the person is with the reconstruction
    • The recovery period
    • What problems, if any, did the person have
    • Would she make the same choice again. 
    • Whether you can see the reconstructed breast.  A reconstructed breast which is likely to look different than a photo or a model.
  • Consider getting a second opinion before having any surgery. Breast reconstruction and even mastectomy are not emergencies. It is more important for you to make the right decisions based on the correct information than to act quickly before you know all your options.

Follow-up care:

  • Everyone should receive a Breast Cancer Follow-Up Plan. Women who have reconstructive surgery are monitored carefully to detect and treat complications, such as infection, movement of the implant, or contracture (the formation of a firm, fibrous shell or scar tissue around the implant caused by the body's reaction to the implant). Women who have tissue flap reconstruction may want to ask their surgeon about physical therapy which can help adjust to limitations in activity and exercise after surgery.
  • Routine screening for breast cancer is also part of the follow-up, because the risk of cancer cannot be completely eliminated. When women with breast implants have mammograms, they should tell the radiology technician about the implant. Special procedures may be necessary to improve the accuracy of the mammogram and to avoid damaging the implant. However, women who have had reconstructive surgery on both breasts should ask their doctors whether mammograms are still necessary.

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