Breast Reconstruction

Breast Reconstruction: All you Need to Know ( Costs,Procedure,Risks…)

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What is a Breast Reconstruction Procedure?

Breast Reconstruction: The goal of Breast Reconstruction is to create a soft, natural-looking breast for a woman who must undergo breast removal (mastectomy) or partial breast removal (lumpectomy) due to cancer or another disease.

Breast Reconstruction is an operation to try to get back the shape of the breast after mastectomy procedure (removal of a breast), or lumpectomy (removal of part of the breast).

The aim of breast reconstruction is to match the remaining natural breast as closely as possible.

There are two main ways of making a new breast;

  1. This can either be done by creating a breast ‘form’ with an implant, which is put underneath the skin and muscle that covers your chest,
  2. Or by using skin, fat (and sometimes muscle or with your own living tissue), taken from another part of your body)

Your surgeon will advise you on the type of breast reconstruction that is most suitable for you. It will depend on:

  1. The amount of breast tissue that has been removed
  2. The healthiness of the tissue at the planned operation site
  3. Whether or not you have had radiotherapy to the area of the breast or chest wall
  4. Your general health and body build
  5. Your wishes and lifestyle.

Your breast reconstruction surgeon aims to create a breast similar in size and shape to your own breast. It is important for candidates to note that a reconstructed breast won’t be identical. When you are naked you are likely to notice differences in symmetry and shape. After your reconstruction, you may need to have further surgery to create a nipple or change the shape of your other breast to match your reconstructed one. It is possible to create a new nipple and this is usually done as a separate operation once the reconstructed breast has settled into its final shape. However, this does not have to be done unless you wish.

You can have reconstruction at the same time as your breast cancer surgery or later. It is a very personal decision and there is no right or wrong way to approach it. Doctors call it the two types of reconstruction either;

  1. Immediate reconstruction– if done at the same time as your breast cancer surgery
  2. Delayed reconstruction– if done later

Description

Breast Reconstruction is an operation to try to get back the shape of the breast after mastectomy procedure (removal of a breast), or lumpectomy (removal of part of the breast

Variations of technique

Several variations, mainly skin expansion with breast implant, or flap reconstruction

Length of Surgery

1-6 hours depending on procedure method

In/Outpatient

Usually an in-patient

Anesthesia

intravenous sedation and general anesthesia

Back to work in…

2-3 weeks depending on individual

Back to the gym in…

4-6 weeks

Cost

National average:

Treatment Frequency

$3,618

Risks

Bleeding ,Fluid collection with swelling and pain ,Excessive scar tissue Infection ,Tissue necrosis (death) of all or part of the flap ,Problems at the donor site (immediate and long-term)

Duration of results

Permanent

Breast Reconstruction Surgery Costs*

The American Society of Plastic Surgeons quoted the national average for Breast Reconstruction is $3800. A surgeon’s cost for breast reconstruction may vary based on his or her experience as well as geographic location.

Many cosmetic surgeons offer patients breast reconstruction financing plans, so be sure to ask.

Costs may include:

  1. Surgeon’s fee
  2. Hospital or surgical facility costs
  3. Anesthesia fees
  4. Prescriptions for medication
  5. Post-surgery garments, and
  6. Medical tests and x-rays

In 1998, the Women’s Health and Cancer Rights Act was passed, which requires all health insurance providers who cover mastectomy procedure to also cover the costs of breast cancer reconstruction for mastectomy patients. However, your coverage may only provide a small part of the total fee.

When choosing a cosmetic surgeon for breast reconstruction, remember that the surgeon’s experience and your comfort with him or her are just as important as the final cost of the surgery. Your satisfaction involves more than a fee.

Am I candidate for Breast Reconstruction Surgery?

Almost every woman who has lost a breast to cancer or another illness can have her body restored with breast reconstruction surgery. However the following conditons are desirable for an ideal candidate;

As a candidate for breast reconstruction surgery it is important that you understand that although your figure will be significantly improved, your reconstructed breast will not look or feel exactly the same as the breast or breasts that were removed.

Your Oncologist has advised you that breast reconstruction is appropriate for you with regard to your cancer or treatment, and you have his or her full approval. (Should cancer recur your reconstructed breast will not interfere with further treatment, however such treatment may possibly affect the appearance of your reconstructed breast.)

You should feel that you will be ready to handle the period of emotional adjustment that may accompany breast reconstruction surgery. It will take time to adjust to a new reconstructed breast as accept it as your own.

It is also important that when deciding to have breast reconstruction surgery that you have no other additional health concerns that could complicate the procedure such as obseity, or heart disease.

Preparing for Breast reconstruction Surgery

One of the first steps you will take after you have made the choice to have a breast reconstruction operation is to have a consultation with your chosen surgeon. During this meeting he will assess your physical and emotional health and well-being and discuss your specific goals and objectives for the procedure.

You will probably be asked by your surgeon to provide the following information during this consultation;

  1. Previous surgical procedure
  2. Past and present medical conditions
  3. Medications you are taking, including dietary or herbal supplements
  4. Past experience with weight loss and the effect it has had on your breast size

To help determine which reconstruction method will give you the best results as an individual, your surgeon will perform a physical exam, during which he or she will take measurements and photographs for your medical record.

When the date for your breast reconstruction procedure has been set, your oncologist and cosmetic surgeon may provide you with specific instructions for the days prior to your surgery and also for after surgery. A number of points may be covered which will could include;

  1. Avoiding medications that may complicate surgery or recovery
  2. Stopping smoking for a period of time before or after surgery
  3. Arranging for help or special care following surgery

Breast Reconstruction Surgery Procedure Steps

Breast Reconstruction operations usually involve more than one operation. The first stage, whether performed at the same time as the mastectomy or later on, is typically performed in a hospital. Follow up procedures may be performed in a hospital, an outpatient surgery center or an office based surgical suite.

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.

Step 2

Flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound. Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.

A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.

A latissimus dorsi flap uses muscle; fat and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.

Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.

Step 3

Tissue expansion stretches healthy skin to provide coverage for a breast implant.

Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process.

It requires many office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.

Step 4

Surgical placement of a breast implant creates a breast mound.

A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction.

Your surgeon will help you decide what is best for you. Reconstruction with an implant alone usually requires tissue expansion.

Step 5

Grafting and other specialized techniques create a nipple and areola.

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola

Breast Reconstruction Surgery Recovery and Healing

When your breast reconstruction procedure is complete, you will be taken to a recovery area. Small drainage tubes may have to be placed beneath the skin near the surgical sites to help prevent fluids from accumulating.

Recovering from a combined mastectomy and reconstruction or from a flap reconstruction typically takes longer than recovery from an implant reconstruction or a reconstruction performed apart from the mastectomy.

Breast Reconstruction recovery times are individual to every patient.
Your recovery may follow this time line:

Within one week

  1. Surgical drains (if used will be removed and dressings will be changes
  2. Stitches will be removed

After two weeks

  1. Lingering soreness at the surgical sites usually tends to diminsh around this time
  2. You should start to feel less fatigued and regain some energy at this point

After several weeks

  1. You should be able to return to most of your normal activities and routine, including sports and other physical activity
  2. You may begin stretching exercises with the guidance of your cosmetic surgeon
  3. Your scars should start to fade, although it may take many months to see substantial fading

After the initial healing period you will return to your cosmetic surgeons office for a post-operative follow up visit so that your healing and progress can be evaluated.

You may find that sensation may return to some areas of the breast, however it is important to note that a reconstructed breast will never feel completely normal or have normal sensation.

Breast reconstruction surgery can provide great physical and emotion rewards, and for many women it represents a chance to have a fresh start and put breast cancer and other illnesses behind them and get on with their lives.

A period of some adjustment is quite normal for you to get used to your new look, However, any concerns about your new shape are likely to pass within a few months, as you begin to think of the reconstructed breast as your own.

Breast Reconstruction Surgery Recovery and Healing

When your breast reconstruction procedure is complete, you will be taken to a recovery area. Small drainage tubes may have to be placed beneath the skin near the surgical sites to help prevent fluids from accumulating.

Recovering from a combined mastectomy and reconstruction or from a flap reconstruction typically takes longer than recovery from an implant reconstruction or a reconstruction performed apart from the mastectomy.

Breast Reconstruction recovery times are individual to every patient.
Your recovery may follow this time line:

Within one week

  1. Surgical drains (if used will be removed and dressings will be changes
  2. Stitches will be removed

After two weeks

  1. Lingering soreness at the surgical sites usually tends to diminsh around this time
  2. You should start to feel less fatigued and regain some energy at this point

After several weeks

  1. You should be able to return to most of your normal activities and routine, including sports and other physical activity
  2. You may begin stretching exercises with the guidance of your cosmetic surgeon
  3. Your scars should start to fade, although it may take many months to see substantial fading

After the initial healing period you will return to your cosmetic surgeons office for a post-operative follow up visit so that your healing and progress can be evaluated.

You may find that sensation may return to some areas of the breast, however it is important to note that a reconstructed breast will never feel completely normal or have normal sensation.

Breast reconstruction surgery can provide great physical and emotion rewards, and for many women it represents a chance to have a fresh start and put breast cancer and other illnesses behind them and get on with their lives.

A period of some adjustment is quite normal for you to get used to your new look, However, any concerns about your new shape are likely to pass within a few months, as you begin to think of the reconstructed breast as your own.

Questions to Ask a Surgeon About Breast Reconstruction Surgery

Knowledge is power so arm yourself with the facts before making any decision about Breast Reconstruction Surgery; here is an essential check list to help you find the right Perfect Yourself Surgeon.

  1. Am I a good candidate for Breast Reconstruction Surgery?
  2. Are my described expectations realistic?
  3. Where is the Breast Reconstruction surgery performed?
  4. How long will the Breast Reconstruction take?
  5. What kind of anesthesia is used Breast Reconstruction?
  6. What is your experience in performing Breast Reconstruction surgery?
  7. Can I see your qualifications?
  8. Can I see Breast Reconstruction before and after photos of recent surgeries you have performed?
  9. What percentages of your Breast Reconstruction patients have had significant post-surgical complications? (surgeons should disclose this information to you)
  10. Who will be assisting my surgery? Can I see their qualifications?
  11. How much will my Breast Reconstruction surgery cost?
  12. Do you offer patient financing? (Flexible payment schemes for your surgery)
  13. Will you repeat/correct procedures if the agreed goals are not met? If this is the case, will I be charged again?
  14. Ask to observe the exact procedure you are considering before you decided to have surgery if you are unsure (this could be on videotape or in real life).
  15. What is the recovery and healing period for Breast Reconstruction surgery? When can I resume full normal activity?
  16. Have you ever had your malpractice insurance coverage denied, revoked, suspended
  17. Ask for and follow up on patient references (these can be invaluable to finding out what your surgeon is really like and the level of customer satisfaction he/she has received in the past)