Written by Dr. Stacey June
Like all fields of medicine, the world of reconstructive surgery is constantly changing. In recognition of this Breast Cancer Awareness Month, we will be discussing breast reconstruction in today’s age, and some of the factors one may consider when faced with this decision. In 2023, patients may be able to find solace in the fact that the field has advanced and now presents more options than ever for their reconstruction journey–in fact, current trends lean towards newer, more conservative procedures such as fat transfers & 3D tattoos, and methods like pre-pec & DIEP flap reconstructions offer significant improvement to the level of muscle injury a patient may sustain.
Here are some of the questions and considerations you may want to keep in mind as someone interested in breast reconstruction…
The type of mastectomy you have could change your reconstruction options:
Most women today qualify for skin sparing mastectomy, which leaves some skin for the plastic surgeon to use in the reconstructive surgery. Some women qualify for nipple sparing mastectomy. In this surgery, the breast surgeon will shell out the breast tissue while leaving the skin, nipple, and areola for the plastic surgeon to use in the reconstructive surgery. Some women qualify for reduction patterned mastectomy in which a larger droopy breast is lifted, and skin is reduced at the time of mastectomy. A discussion between your breast surgeon and plastic surgeon will help to guide you on the best options for the perfect blend of both oncologic safety and best cosmetic result.
Implant vs. autologous tissue:
Implant reconstruction has become exceedingly popular due to the ability to reconstruct the breast with an implant and avoiding the need to borrow tissue from another part of the body. Newer, smooth, round silicone gel implants are safe and feel natural. This surgery often requires a staged procedure, starting first with a tissue expander, then a smaller procedure to exchange tissue expander for a permanent implant. This surgery is now often performed above the chest muscle (pre-pec) with support of a mesh product and is often supplemented with fat transfer for a more natural result.
Autologous tissue utilizes tissue from another part of the body to reconstruct the breast, most commonly the abdomen (DIEP flap). This is a longer operation with a longer recovery process but allows you to avoid an implant. DIEP flaps require a surgeon proficient in microvascular techniques. Because it is your own tissue, it may feel and appear more natural and change more with you as you age, gain and lose weight. This surgery is also sometimes staged first with a tissue expander.
Don’t want reconstruction but concerned about “going flat”?
Speak with a plastic surgeon prior to mastectomy. It is true that many women who choose to “go flat” dislike the concave result they are often left with. If you are not interested in an implant nor autologous tissue reconstruction, there are still ways in which your plastic surgeon can help you with a cosmetic closure. We can utilize your left-over soft tissues to still give you a small but aesthetically pleasing contour. If you are still with some irregularities with this “in between” surgery, you still have future options like adding more volume with a transfer of fat or doing a delayed reconstruction (implant or autologous flap, later on).
Reconstructing the nipple and areola:
Once you have completed the reconstruction of the breast mound, your plastic surgeon will discuss nipple and areola reconstruction. A projecting nipple can be made using local soft tissue, grafts, and/or implanted material. Color can also be added with tattoo. The appearance of a nipple and areola could also be made with a 3D tattoo by a proficient tattoo artist.
Not just for mastectomy patients:
Lumpectomy patients can often be candidates for oncoplastic breast reconstruction if there is potential for your lumpectomy and radiation to leave you with an indentation or volume discrepancy. Procedures that can be done at the time of (or soon after) lumpectomy include breast reduction, mastopexy, and soft tissue rearrangement. This would ideally be done before any radiation to the breast. However, even after radiation has been completed, there are some options such as implants, autologous tissue flaps, and fat transfer.
What about the noncancer opposite breast?
Whenever breast cancer has the potential to leave you with an asymmetry between your breasts, you should meet with a plastic surgeon to discuss your surgical options. Your insurance will pay for symmetry procedures that can be done at the same time as the cancer breast or at a future date. This could include making the breast bigger, smaller, or more lifted, through procedures such as breast reduction, mastopexy, soft tissue rearrangement, fat transfer, or implant.
Which types of breast reconstruction are covered by insurance companies?
All topics discussed here are covered by insurance companies. It is federally mandated that once an insurance company pays for your mastectomy–they must not only pay to reconstruct that breast, but they will also pay for symmetry procedures and staged procedures. Revisions are often needed and should all be covered by your insurance. Whichever procedure you and your surgeons choose, the surgeon’s office will contact your insurance company to assure coverage and define any out-of-pocket costs (IE deductible/coinsurance) prior to said procedure.
In 2023, knowledge is power. It may seem overwhelming to discuss these issues with a new diagnosis of breast cancer, but it is important to know all your options to help you make a better decision on how you want to proceed with the reconstruction of your body.
To discuss your breast reconstruction options with one of the Board-Certified Plastic Surgeons at Advanced Specialty Care, contact our office today by calling us or requesting your appointment online. Breast reconstruction consultations are available in one of our 4 convenient office locations in Danbury, New Milford, Norwalk and Ridgefield, CT.
Dr. Stacey June is a board-certified Plastic, Reconstructive & Hand Surgeon specializing in breast surgery, including breast augmentations, lifts, reductions, male breast reduction, post-mastectomy breast reconstruction as well as facelifts, necklifts, eyelid surgery, liposuction, tummy tucks, mommy makeovers, excess skin removal, body procedures, reconstruction following trauma or surgery, treatment of hand conditions, and non-surgical cosmetic procedures such as Botox & Fillers and more. She sees patients at Advanced Specialty Care’s Danbury, CT and Ridgefield, CT offices.
ADVANCED SPECIALTY CARE
Advanced Specialty Care’s Plastic, Cosmetic & Reconstructive surgeons have been rated and awarded as some of the very best in Connecticut, offering the newest and most sophisticated cosmetic & plastic surgery procedures, reconstructive surgeries and non-invasive treatment options for patients of all ages. Call today or request your appointment online with a doctor at any of our convenient offices in Danbury, New Milford, Norwalk, and Ridgefield, CT.