Breast reconstruction is not only an option but a right for women seeking to rebuild one or both breasts following surgical treatment of breast cancer, including lumpectomies and mastectomies. These surgical services are typically covered by insurance as the 1998 Women’s Health and Cancer Rights Act specifies that healthcare insurers must cover breast reconstruction following mastectomy. It also stipulates that any surgery needed to the opposite breast (i.e. lift, reduction or augmentation) to obtain symmetry will also be covered.

There are several different options for breast reconstruction. Breast reconstruction following mastectomy can be performed using the patient’s own tissue (autologous reconstruction) or with breast implants, and sometimes a combination of both. Breast reconstruction can take place in a single surgery immediately following a mastectomy known as immediate reconstruction, or any time thereafter the surgery referred to as delayed reconstruction. Immediate breast reconstruction has the significant psychological benefit of a patient forgoing a period of time being without a breast mound. Sometimes though, for reasons related to a patient’s breast cancer, it may be preferable to delay breast reconstruction. This is something you should speak with your breast and plastic surgeon about. Breast reconstruction following lumpectomy often involves a breast reduction or moving around breast tissue to help result in a more aesthetic outcome. Fat grafting can also be utilized to help smooth contours.

There are several techniques that can be used for breast reconstruction. The most common form of reconstruction involves the use of breast implants. In implant-based breast reconstruction, the use of tissue expanders and a 2-stage approach is most common. In this procedure, the surgeon inserts a temporary implant either above or below the chest wall muscles typically at the time of the mastectomy. Often a dermal-mesh will also be used to support the expander and breast skin. After an overnight stay in the hospital, patients are discharged home and over several weeks in the comfort of the office, saline is injected into the expander, stretching the breast skin to create a pocket (or space) for a permanent breast implant. Once the desired size is achieved, the expander is removed and replaced with an implant as an outpatient procedure. Other procedures can be combined with this second stage, such as fat-grafting to improve contours, or procedures for the opposite breast if needed for symmetry.

Alternatively, autologous reconstruction is a very popular choice, especially if an implant is not desired or indicated. In this procedure, the surgeon takes tissue from other parts of the patient’s body to reconstruct the breast. Potential donor sites include the abdomen,  back, or thighs, with the abdomen typically being the most preferred option. If the donor tissue is taken from the patient’s abdomen, the procedure removes the skin and fat that is commonly removed in an abdominoplasty, also known as a tummy tuck and transfers that tissue to the chest wall to reconstruct a breast. Autologous reconstruction typically requires microsurgical techniques, and a longer hospital stays,  but this method provides a lifelong result and some studies have shown higher patient satisfaction.

Finally, nipple and areolar reconstruction can be helpful in completing the aesthetic reconstruction in patients who have not been able to keep their own. Nipple reconstruction can be performed with one’s own tissue (to create a projecting nipple) or with the use of 3-D tattooing and is typically performed as a separate procedure as reconstructed breasts need to heal for optimal placement of the new nipple. Areolar tattooing is an option that can be done after nipple reconstruction, also allowing for camouflaging of scars. Alternatively, with 3-D tattooing, both the nipple and areola can be created in one step without a formal reconstruction.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts. This and other procedures are performed at our Monmouth County office.

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