Several different variables must be factored in to choosing the surgical approach that's right for you:
1. Personal preference. Alloplastic or autologous implants? Immediate or delayed reconstruction? How many “stages” of surgery are you willing to undergo? These are only a few of the decisions you will face. As you and your plastic surgeon discuss the plan of action, chances are you will have to delve into more detailed information before deciding on a procedure.
2. Type of Mastectomy. Your breast surgeon and oncoplastic surgeon will work together to tailor your mastectomy to the type of reconstruction you prefer. Types of mastectomy include:
- Breast lift/reduction pattern
If you have already had a mastectomy and are considering reconstructive surgery, the surgical plan will be based on the type of mastectomy you had.
3. Cosmetic Concerns. Breast conserving lumpectomies are more common thanks to today’s highly targeted surgical and radiosurgical techniques. However, once tissue heals and swelling subsides, women may be left with asymmetry or indentations in the breast, or changes in firmness or pigmentation. Depending on the cosmetic issue, different surgical techniques may be appropriate.
4. Treatment Plan. If you are going to have radiation after mastectomy, there are new algorithms that can integrate and combine reconstruction and radiation that allows for the completion of both treatment modalities.
5. Body Type. Women who are having bilateral prophylactic mastectomies have more leeway when it comes to determining the size and shape of their reconstructed breasts because the surgeon doesn’t have to match the healthy breast. If you have a remaining healthy breast, its size and shape will guide the design of the reconstructed breast. If you choose to have autologous implants, your anatomy will play a role. Some women don’t have enough body fat to create a flap from abdominal tissue.
Your medical team and plastic surgeon will work with you to arrive at the right treatment plan. In the meantime, it’s a good idea to get familiar with the most common breast reconstruction procedures.
The Women's Health and Cancer Rights Act of 1998 (WHCRA) requires all health plans that cover mastectomies include post-mastectomy and reconstructive surgery benefits. As a result, breast reconstruction is covered by most health insurance policies, although the specific procedures covered and the amount of coverage provided varies depending on the policy. If you have lost or damaged a breast due to accident or injury, you need to look at your individual policy to see what kind of coverage is offered. Check with your State Insurance Commissioner’s office and/or your insurance provider for the specifics of your particular policy.