After a mastectomy, a woman might choose to wear a breast form (prosthesis) that fits in her bra or a specially designed bra with a breast form built into it, have her breast reconstructed by a plastic surgeon, or do neither. Some women choose to get body art tattooed over their mastectomy scars. Others opt not to have a breast form, tattoo, or reconstructed breast. This is a highly personal decision. Discuss your options with your plastic surgeon to help you decide the best option for your comfort and appearance.
If you have a mastectomy, there are different types of breast reconstruction available. It is important to know that a rebuilt breast will not have natural feelings or functions; but the surgery can give you a result that looks like a breast. If you think that you want breast reconstruction, it is important to discuss reconstruction with your surgeon before your mastectomy and ask for a referral to an experienced plastic surgeon. Many women start reconstruction at the same time as their mastectomy; some wait several months or even years.
Breast reconstruction - surgery to "rebuild" a breast - is an option for anyone who has lost a breast because of cancer. New York State law requires health insurance policies that provide medical and surgical coverage to pay for reconstruction and for surgery to the other breast to obtain a good match. Required payment for breast reconstruction does not apply to self-insured health plans or to some plans paid for by out-of-state employers. If you have questions about legislation on breast reconstruction or other insurance legislation, call the New York State Department of Financial Services at 1-800-342-3736.
If you are considering breast reconstruction surgery, this section gives information on the types of surgeries available.
Reconstruction with Implants
Implants are plastic sacs filled with silicone (a type of liquid plastic) or saline (salt water). The sacs are placed under your skin behind your chest muscle. Implants may not last a lifetime, and you may need more surgery to replace them later. Sometimes saline implants "crinkle" at the top, or can shift with time, but many women don't find these changes troubling enough to have the implant replaced.
The Food and Drug Administration (FDA) has studied the safety of silicone breast implants and the immune system for several years; the most recent research shows that these implants do not cause immune system problems. The FDA approved two kinds of silicone implants for breast reconstruction surgery in 2006. If you are thinking about having silicone implants, you may want to talk with your surgeon about the FDA findings and whether silicone implants are an option for you.
Breast Reconstruction with Implants
Possible Side Effects of Reconstruction with Implants
People who have had reconstruction with implants sometimes have pain, infection, or rupture (breaking) of the implant. Additionally, some people may not be happy with how the results look, or scarring could form around the implant over time, making the reconstructed breast look less attractive.
Reconstruction with Tissue Flaps
Tissue flap surgeries use muscle, fat, skin, and blood vessels moved from another part of the body to rebuild the breast. This tissue can be taken from the:
- Lower stomach area (known as TRAM Flap or DIEP Flap)
These surgeries also sometimes use an implant to make the new breast match the opposite breast. A woman starting this process should know that it often takes more than one surgery. Extra steps may include adding a nipple, surgery on the opposite breast to create a good match, and perfecting the shape of the rebuilt breast.
Breast Reconstruction with Tissue Flaps
Possible Side Effects of Reconstruction with Tissue Flaps
These surgeries leave scars in two places - one where the tissue was taken from and one on the new breast. The scars may fade over time and may never go away completely. There also might be muscle weakness where the tissue was taken, differences in the size and shape of the breasts, or poor blood supply to the new breast. Choosing a plastic surgeon that has been trained in this surgery and has performed it successfully on many other women can reduce the risks.
To find certified plastic and reconstructive surgeons in your area, visit the American Society of Plastic Surgeons website at: www.plasticsurgery.org/ or call 1-888-4PLASTI (1-888-475-2784).
For more information about companies that sell breast prostheses, visit: www.cancer.org/Cancer/BreastCancer/MoreInformation/breast-prostheses-and-hair-loss-accessories-list.