Every woman has a right to breast reconstruction

Dr Minas Chrysopoulo has offered to write some information on various breast reconstruction issues. What he writes is from his point of view and knowledge. I hope that the series is of interest and help to those who live through breast cancer and helps those who love them understand the issues more clearly.

This article is the first of a 3-part series on breast reconstruction surgery introducing the reconstructive options available to women facing mastectomy for breast cancer.

Breast Reconstruction Surgery: What Every Woman Needs To Know – Part I

By Minas Chrysopoulo, MD

Every woman has a right to breast reconstruction. This has now actually become a federal mandate and insurance companies have to cover all types of breast reconstruction by law. Having said that, it’s also important to remember that it’s not up to the health insurance to decide which reconstruction a woman receives. That’s determined by the woman and her surgeons. Breast reconstruction is not a form of cosmetic surgery – it restores something that nature has provided but cancer has taken away.

There is also no age limit – as long as there are no medical conditions making the surgery unsafe and the breast cancer is diagnosed at an early enough stage, most women are candidates for the surgery. Breast reconstruction can be performed as an immediate or delayed procedure. As the term implies, immediate reconstruction is performed immediately after the mastectomy, while the patient is still under anesthesia. Once the general surgeon has completed the mastectomy, the plastic surgeon begins creating the new breast. Advantages of this approach include the option of preserving most of the breast skin (skin-sparing mastectomy) and a shorter scar. The woman also wakes up “complete” and avoids the experience of a flat chest. Immediate reconstruction provides the best cosmetic results.

Delayed reconstruction generally takes place several months following mastectomy. Women who need to undergo radiation after mastectomy may be advised to delay reconstruction in order to achieve the best results. This delay may last several months in order to allow the tissues to recover as much as possible from the radiotherapy. There are several reconstructive options, ranging from breast implants to autologous techniques using the woman’s own tissue to recreate a more “natural,” warm, soft breast. The nipple and areola can also be restored.

Tissue Expanders and Breast Implant Reconstruction: This is the most common method of reconstructive breast surgery currently being used in the United States. Most surgeons perform this is a 2-stage procedure. The tissue expander is essentially a temporary breast implant which can be placed either at the same time as the mastectomy or after the mastectomy has healed. The expander is used to stretch the skin envelope and recreate the size of breast the woman wants. The expander is ultimately replaced by a permanent implant (saline or silicone) in a separate procedure several months later.

Some women undergoing immediate breast reconstruction are candidates for one-step breast implant reconstruction whereby a permanent implant is inserted at the time of the mastectomy and the woman avoids going through the whole expansion process. In the one-step implant reconstruction the implant is completely covered by the pectoralis muscle and Alloderm (a cadaveric acellular dermal graft). This is specially treated skin from a cadaver that’s used to provide a sling and coverage of the lower part of the implant.

Two types of implants are available to patients: saline and silicone.

Complete implant coverage – breast implant placed under the pectoralis muscle.

Lower portion of implant covered by Alloderm sling.

Image provided by Dr. Chrysopoulo by way of Lifecell.

There are many opinions regarding both types of implants and it is advised that you speak with your surgeon as to which implant would be best for you. Women who undergo implant reconstruction should be aware that their breast implants may need to be replaced at a future date. Implant reconstruction can be the best option for some women. However, tissue expanders and implants can be fraught with complications long-term, particularly if the woman has had or is going to have radiation therapy as part of her cancer treatments. For these reasons, many surgeons and women prefer autologous reconstruction, i.e. reconstruction using the woman’s own tissue taken from another part of the body. These will be discussed in upcoming posts. Part II of the series is Muscle flaps in breast reconstruction surgery after breast cancer and part III on December 31, 2008.

Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery including the Alloderm one-step and DIEP flap procedures. In-network for most US insurance plans. Toll Free (800) 692-5565. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.

Note from Marijke: I don’t have any personal experience with breast cancer and reconstruction issues. The information, particularly of the Alloderm and DIEP flap procedures, is provided by the doctor’s knowledge and experience.

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Tags: cancer blog, breast cancer, breast reconstruction, saline breast implants, silicone breast implants, breast cancer reconstruction, alloderm, DIEP flap procedure, mastectomy, skin sparing mastectomy, tissue expanders in breast reconstruction