Breast Reconstruction FAQ

If you are interested in breast reconstruction, some practical questions you may want to think about include:

• Should my reconstruction be immediate or delayed?
• Who will do my reconstruction?
• Who will pay for my reconstruction?
• Should I have mammograms after my reconstruction?

Should my reconstruction be immediate or delayed?

You've talked with your doctor and decided to have your breast reconstructed. Should you have it done at the same time as the mastectomy or wait until later? All types of breast reconstruction can be done either at the same time the cancerous breast is removed or later--even years later. Your doctor may suggest that one option is better for you, depending on your body and your health.

Advantages of Immediate Breast Reconstruction:

• You wake up after cancer surgery with a new breast, or the beginnings of a new breast, already in place.
• Most women feel better about seeing the results of the cancer surgery for the first time if they have had immediate reconstruction.
• It saves time and effort, since you have two surgeries at the same time.

Disadvantages of Immediate Breast Reconstruction:

• You must bear the strain and the possible problems of two surgeries at once.
• There is no chance to adjust to the loss of the old breast before you get the new one.
• You must deal emotionally with cancer and with reconstruction at the same time. Some women prefer to have the cancer treated first and to think about reconstruction afterwards.

Who will do my reconstruction?

The breast reconstruction is done by a plastic surgeon. While your surgical oncologist is responsible for your mastectomy and treating your cancer, your plastic surgeon focuses on reconstructing your breast. If you decide to have immediate reconstruction, the plastic surgeon will need to coordinate with your oncologist to plan your surgery.

Plastic surgeons are first trained as medical doctors. After medical school, they receive five to eight years of specialized training in plastic surgery. Plastic surgeons perform many complicated surgeries. They re-attach hands after accidents, reconstruct body parts for burn patients, and repair wounds. However, it is always good to ask if your surgeon has experience in breast reconstruction. You should make sure that your doctor is a "board certified" or "board eligible" plastic surgeon. Also, your surgeon should be willing to talk with you about both cosmetic and surgical issues. Remember that the surgeon works for you: you can choose to stop reconstruction at any point, from choosing no reconstruction to declining nipple reconstruction and tattooing.

A PATIENT SAYS. . .

"The choice of surgeon was probably the second most critical factor for me [after deciding to do the surgery and getting information about it]. And finding someone I felt very optimistic with and encouraged by and felt very much part of a team. So that was the difference in talking with someone who's only done a few of these surgeries and then talking with someone like Dr. ____ who has done so many of them, really made me feel far more comfortable."

Who will pay for my reconstruction?

Insurance companies and managed care organizations are now required to pay for breast reconstruction for women who have had a mastectomy. Health care plans are also required to pay for surgery to make the opposite natural breast match the reconstructed breast. The Women's Health and Cancer Rights Act of 1997, which ensures these rights, states that:

"A group health plan, and a health insurance issuer providing health insurance coverate in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall ensure that, in a case in which a mastectomy patient elects breast reconstruction, coverage is provided for--

1. all stages of reconstruction of the breast on which the mastectomy has been performed; and
2. surgery and reconstruction of the other breast to produce a symmetrical appearance;

in the manner determined by the attending physician and the patient to be appropriate, and consistent with any fee schedule contained in the plan."

This law is also observed by Medicare and Medicaid. However, you should still check with your insurance company ahead of time - most companies require that you obtain authorization in advance about any surgery that is not an emergency. Also, not all insurance companies cover nipple tattooing, so ask about this procedure if you think you would like to have it done. If you do not have insurance, you should talk with your doctor about the cost of the breast reconstruction surgery, office visits, and potential additional costs due to implant or TRAM complications.

Should I have mammograms after my reconstruction?

If You Had an Implant:

If you have had an implant, mammograms are usually not recommended for the reconstructed breast. Most physicians prefer to screen for local recurrence of cancer with physical examinations of the breast.

Do self breast exams on both breasts once a month and visit your doctor as recommended for a checkup. Continue to have mammograms done on the natural breast as recommended by the American Cancer Society or your physician. (American Cancer Society guidelines are listed below for your convenience.)

If You Had Natural Tissue Reconstruction:

Increasingly, providers are recommending that TRAM reconstructions be periodically screened with mammograms. Try to find a mammography facility that is experienced in doing mammograms on reconstructed breasts. In addition, most physicians also rely on physical examinations of the breast to detect cancer recurrences. Do self-exams on both breasts once a month and visit your doctor as recommended for a checkup. Continue to have mammograms done on both breasts as recommended by the American Cancer Society or your physician. (American Cancer Society guidelines are listed below for your convenience.)

For more information, see the MBROS Study Results on Mammography After TRAMs ("Tramograms").