Breast Reconstruction

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Breast reconstruction surgery is a procedure used to improve the shape of the breasts following mastectomy for breast cancer treatment, trauma, or medical conditions causing loss of breast tissue. For cancer patients, cancer survivors, and trauma survivors, breast reconstruction provides the possibility of restoring the breasts to a natural and feminine shape, improving patients’ self-confidence. Breast reconstruction is among the most rewarding procedures offered by plastic surgeons.

During breast reconstruction, additional tissue is added to the breast area to increase breast volume. The natural tissues of the breast area are also sculpted to optimize the appearance of the breasts. This procedure, which is typically covered by health insurance, aims to create a more natural appearance in the breast area following traumatic loss of breast tissue.

Are You a Candidate?

Unlike many other plastic surgery options, breast reconstruction is not intended for purely cosmetic purposes. Candidates for breast reconstruction are seeking a more natural silhouette through restoring the normal shape, size, and appearance of the breasts. Whether the breast has been removed to treat breast cancer or as a pre-emptive treatment in women with a high risk of cancer due to family history, breast reconstruction can restore the natural silhouette of the breast. This procedure is available for women who have lost one or both breasts.

If you have lost one or both breasts, consult with a plastic surgeon to determine whether this procedure is right for you. Ideal candidates, although they may be cancer patients or cancer survivors, are in good overall health and at or near their ideal weight. Because breast reconstruction is considered invasive surgery, you must be healthy enough to undergo surgery. After all that you have been through, breast reconstruction offers the possibility of restoring a more natural breast silhouette, and with it, your self-confidence.

Breast Reconstruction Techniques

Breast reconstruction surgery is often combined with the initial mastectomy, or removal of natural breast tissue. In this case, the surgery is often longer then when performed alone, but the patient is spared having to go any length of time without breast tissue. Breast reconstruction can also be performed at any point after the loss of breast tissue.

There are several decisions to make regarding the type of tissue that will be inserted to simulate natural breast tissue. The breasts are frequently reconstructed using the same type of silicone or saline breast implants that would be used for breast enlargement procedures. It may also be performed using donor skin, muscle, and fat transferred from elsewhere on the body, such as the back or buttocks. While this method can result in a more natural texture in the reconstructed breast, it also requires a donor site, and is typically a longer procedure with an extended recovery period, which can include one or two additional nights in the hospital, as well as a scar in the donor area.

In cases in which the nipple and areola must be reconstructed in addition to adding volume to the breast tissue, skin grafting is most often used, as it results in the most natural appearance. The combination of skin grafting and donor tissue has made it possible for surgeons to closely approximate the look and feel of natural breast tissue.

Regardless of the exact type of breast reconstruction being performed, the procedure requires general anesthesia. It can take anywhere from two to six hours; longer procedures are typically those combined with the initial mastectomy or using donor tissue. Breast reconstruction requires a flap or incision, through which the surgeon adds implants or donor tissue, sculpting the breast to the desired shape.

Recovery Time

Breast reconstruction, a procedure which takes two to six hours, is performed with general anesthesia. Afterwards, you can expect to feel groggy, tired, disoriented, and possibly nauseous. All are common side effects of the anesthesia. Depending on the patient’s overall health and the extent of the surgery, breast reconstruction recovery patients may spend anywhere from one to six nights in the hospital.

Most breast reconstruction surgery patients experience some degree of pain, soreness, or tenderness, as with any invasive surgical procedure. Pain medications can reduce any discomfort, which can be expected to last for about a week. Other common side effects include bruising and swelling.

Because breast reconstruction is invasive surgery, it is important to realize that there will be scars. The position of the scars depends on the surgeon’s strategy for accessing the underlying tissues to build up the size and shape of the breasts. These scars will fade over time to blend in with the surrounding skin. In addition, the reconstructed breast may never feel completely normal, as the inserted breast tissue is unable to feel sensations. Still, breast reconstruction patients find that after the recovery process is complete, they have a much more natural-looking chest and increased self-confidence.

Tips to Reduce Swelling after Surgery

Although most of the side effects will begin to subside by the time you leave the hospital, swelling can obscure the results of your  breast reconstruction procedure for several months. This common side effect is experienced by nearly all breast reconstruction patients as their body adjusts to the new tissue. Here are a few tips to reduce swelling:

  • Drink plenty of water
  • Maintain a proper diet that is low in sodium
  • Get plenty of rest
  • Avoid medications that may exacerbate swelling, and let your doctor know about the medications you are taking before your surgery

If the surgeon has placed drains for excess fluid that may collect in the breasts, follow the aftercare instructions provided by your plastic surgeon to avoid excessive swelling. You may also find it helpful to gently massage the treated area several times per day, which can increase the circulation of fluids.

Compression Garments

In addition to the above tips, a surgical bra or compression garment can also reduce swelling, in addition to alleviating discomfort and even reducing the overall recovery period. A surgical bra is a specially-designed bra that will support the breast tissues as they heal. It is especially important to wear the recommended garments for the first few weeks after breast reconstruction, as the skin and natural breast tissues are still getting used to the new shape and size of the breasts. During this time, it is recommended to avoid underwire bras or those that do not provide adequate support. Compression garments, which hold the breasts very close to the body, similarly to a sports bra, help to ensure a comfortable and fast recovery while helping your body get accustomed to its new contours.

Healing Time

Most patients are able to return to their normal activity levels over the next two to four weeks, although this does depend on the patient’s overall health, as well as the extent of the procedure. The recovery period is typically longer when breast reconstruction is combined with the mastectomy. The recovery process is also longer and more complicated when donor tissues are used rather than artificial implants, as the donor tissue site must also heal in addition to the breast area. In addition to the usual swelling, bruising, and tenderness, patients can also expect some numbness in the natural tissues surrounding the reconstructed breast.

What Does Breast Reconstruction Cost?

According to the American Society of Plastic Surgeons, the average surgeon’s fee for breast reconstruction surgery in the United States is about $3,000 to $4,000. However, this amount does not include anesthesia, the surgical facility, or miscellaneous expenses, which can push the total cost up to $5,000 to $8,000. The full cost for breast reconstruction may be even higher depending on the extent of the surgery.

The three basic fees involved in breast reconstruction surgery are the surgeon’s fee, the anesthesia fee, and the facility fee. The facility fee covers the hospital or surgical center where your procedure is performed. The anesthesia fee is paid for the general anesthesia that is required for patients undergoing breast reconstruction. Finally, the surgeon’s fee is the amount paid to the surgeon who is performing your procedure.

Other costs that may be required for your surgery include x-rays and medical tests, medications, supportive surgical garments for the breast reconstruction recovery period, and follow up care, among other miscellaneous expenses.

Factors That May Affect Pricing

These fees can vary significantly from case to case, making it difficult to generalize the costs of breast reconstruction. In general, more complicated procedures also tend to be more expensive. For example, reconstructing both breasts tends to be more expensive than surgery performed only on one side. A procedure involving both mastectomy and breast reconstruction is lengthier and more expensive than either procedure performed alone. The fee also varies depending on the procedure method, such as whether donor tissue or breast implants are used.

In addition to factors related to the procedure itself, the cost of breast reconstruction is also impacted by the surgical facility and the geographic location. In general, surgery tends to be more expensive in large cities. The facility fee can also vary from place to place even within the same metropolitan area.

Finally, the surgeon’s fee is dependent upon the surgeon you choose, including their skills, qualifications, and experience level. Choosing a highly qualified and board-certified plastic surgeon for your breast reconstruction ensures that your surgeon will use appropriate techniques and will perform the procedure with an eye towards reducing your risk of complications. In addition, experienced surgeons understand that plastic surgery is both an art and a science, and will sculpt your breast tissue to give you the most natural contours possible.

When comparing plastic surgeons, never choose based solely on price. The most experienced surgeons are able to command a higher fee because they are recognized as being among the best at what they do.

Covered by Insurance?

Although cosmetic surgery is not usually covered by health insurance, in many cases insurance will cover all or part of your breast reconstruction procedure, depending on the circumstances surrounding it. The 1998 Women’s Health and Cancer Rights Act requires all health insurance providers who cover mastectomy procedure to also cover the costs of breast reconstruction for mastectomy patients. If you are considering breast reconstruction, inquire with your insurance carrier before scheduling the surgery so that you know which, if any, expenses will be your responsibility. As you are probably well aware, insurance carriers often have complicated rules regarding which expenses are covered. They may cover only some types of expenses, or limit you to certain types of reconstructive surgeries. Check your policy to understand your coverage before undergoing breast surgery.

In some cases, your insurance coverage may only pay a small part of this procedure, as reconstructing the appearance of the breasts is not usually medically necessary. If this is the case, you should know that most surgeons offer affordable payment options. Cost should never be the sole reason for avoiding breast reconstruction following the loss of a breast to cancer or trauma.