Your Breast Reconstruction Choices

Having breast reconstruction shouldn't interfere with detection or treatment if your cancer should recur at the same place.

If you decide a mastectomy is the best cancer treatment choice for you or your surgeon recommends it, you have yet another decision to make: whether to have breast reconstruction. Some women are perfectly happy wearing an external breast prosthesis, others believe reconstruction will offer a more familiar fit in their clothes or more confidence.

Though no surgery is risk-free, immediate reconstruction can usually be done with a low risk of complications and a relatively quick recovery. And cost may not need to be a concern, since insurance typically covers all or most of the cost for reconstruction, required by federal law.

Even if you think breast reconstruction is not for you, arrange a consultation with a reconstructive plastic surgeon (your breast cancer surgeon will probably be able to recommend one). You'll be able to discuss your options, learn more about this procedure, and see photos of women who have had it done.

Now or later?

If you opt for reconstruction, you'll need to decide whether to have it at the time of surgery or later.

  • If you don't need radiation, immediate reconstruction is preferable. The surgeon can save extra skin—possibly even your nipple—and the cosmetic result may be better. You'll also be spared additional hospitalization and anesthesia.
  • If you need radiation, it's better to hold off on permanent reconstruction because radiation can affect the new breast. An alternative is a simple expander device that gives you form and keeps your options open.
  • Of course, you may want to simply defer any decision for now and focus all your energy on fighting the cancer.
"Real" or implant?

The next choice is whether to use a "flap" of fatty tissue from another part of your body, or to have an implant. Your plastic surgeon can tell you which option will produce the best cosmetic result. With your own tissue, one of several techniques is used, depending on your body type and preference.

Saline or silicone?

If you choose an implant, your options are saline or silicone gel. Silicone tends to have a more natural look and feel. Often, the implant site must be expanded over a short time using an inflatable device before the implant is inserted. This device is called a tissue expander and it is inserted underneath the muscle at the time of the mastectomy. The tissue expander is inflated a little each week with sterile water. You may also need adjustments done on the other breast to make sure the two match.

The good news is that insurance will also cover this procedure, and you may even be able to get your reconstruction done on an outpatient basis.

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