Reconstructive Breast Surgery

Introductory Note: As always, the information given here is for general informational purposes only. All women about to undergo treatment for breast cancer should consult their health care team about the options appropriate for their particular medical situation.

The American Cancer Society estimates that about 192,200 women in the United States will be diagnosed with invasive breast cancer in 2001. Many of those women whose treatment involves mastectomy (surgical removal of a breast) will have the option of reconstructive breast surgery. According to the American Society of Plastic Surgeons (ASPS), “Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992.”

The ASPS says that most women who have mastectomies are candidates for breast reconstruction. So the first choice a woman facing a mastectomy will have to make is whether or not to have reconstructive surgery. Some women choose not to have reconstructive surgery and decide instead to use a prosthesis, a breast-shaped form that can be inserted into a bra.

Women who decide to have reconstructive surgery will then have to consider whether to have the reconstruction done at the same time as the mastectomy or later. Some women may choose to wait because they don’t feel they can adequately consider all the reconstructive options while coping with a cancer diagnosis and treatment regimen. Also, delayed reconstruction may be necessary for women who will be having radiation therapy after their mastectomy. But the ASPS says that women who want breast reconstruction are increasingly choosing to have it done as the time of mastectomy.

When the two surgical procedures are done at the same time, a surgeon will perform the mastectomy and a plastic surgeon will perform the reconstruction. Several reconstructive techniques are available, including skin expansion followed by an implant or reconstruction with tissue from another part of the patient’s body such as the back, hip, abdomen, or buttocks.

The most common breast reconstructive procedure is skin expansion followed by insertion of an implant. In this procedure, the plastic surgeon inserts a balloon expander under the skin and chest muscle. The doctor then periodically injects salt water into the expander so the skin covering the expander will stretch. It may take several weeks or months for the skin to stretch adequately. Once the skin has expanded, the expander is removed and an implant is inserted. Some expanders are designed to be left in place as the permanent implant.

Other implant approaches involve using a flap of skin from another part of the patient’s body to create a pouch into which an implant can be inserted. In some cases tissue from the patient’s body can also be used to create the breast mound, eliminating the need for an implant.

After the initial reconstructive operation, the plastic surgeon may, if a woman desires, perform another procedure to construct a nipple and areola (the dark circle around the nipple). But a reconstructed breast will not have the same sense of feeling as the original breast. Also, a reconstructed breast may be undetectable when a woman is clothed, but it will always be obvious when she is nude.

The Women’s Health and Cancer Rights Act of 1998, a federal law, requires that medical insurance plans cover the cost of breast reconstruction and alteration of the other breast for symmetry for women who have had a mastectomy.