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One Dozen Facts About Breast Cancer Surgery, Reconstruction

By Patricia Anstett, author of “Breast Cancer Surgery and Reconstruction: What’s Right for You.” (Published June, 2016, Rowman and Littlefield). Available at;

1. Most women diagnosed with breast cancer do not undergo breast reconstruction because they have small, early-stage tumors that can be treated with lumpectomy and radiation. Of 230,000 American women diagnosed annually with breast cancer, about 100,000 have breast reconstruction.

2. Breast reconstruction usually involves two or more procedures. It’s usually not done in a day.

3. Federal law requires that breast reconstruction be paid for by health insurance after a mastectomy. But many states and health plans are exempt.

4. Your health insurance may limit what doctors you can see. It’s also important to ask what your insurance covers and what your out-of-pocket expenses will be.

5. Busty or larger-framed women have fewer breast reconstruction choices and poorer outcomes, studies show, and they often are ineligible for nipple-sparing mastectomy and single-stage implant reconstruction without expanders, an operation known as direct-to-implant reconstruction. Top teams, however, are more open to performing nipple-sparing mastectomy on larger women, with good results.

6. Most breast reconstruction is performed with breast implants. Doctor and hospital referral patterns lead to implants as a choice, along with quicker recovery from implant reconstruction.

7. One in 10 women choose so-called autologous reconstruction with their own tissue. Only a sparse number of plastic surgeons have advanced training in microvascular techniques to perform the most common one called a DIEP flap, shown in studies to have the best outcomes.

8. Breast reconstruction often is done at the time of mastectomy but 3 of 10 times women wait months, even years, because they need chemotherapy or radiation first; prefer to give their bodies time to heal; or want time to sort out their options.

9. The nipple can be hard to recreate surgically. Some women never go back to get nipples after a mastectomy or live with less-than-perfect results. Some leading teams refer women to commercial tattoo artists because they consider their machines and inks better than those in many
medical offices. Also, it’s important to know that most women say they lose sensation in the nipple after breast reconstruction.

10. If you don’t like your initial results, you may need to search for reconstruction specialists good at fixing problems, particularly those that occur after an infection or radiation. Top teams that do hundreds of breast reconstruction procedures a year devote a third or more of their practices to so-called breast revision. Plastic surgeons who perform cosmetic as well as reconstruction procedures may not have the skills to address more complicated problems.

11. Women as young 20, who have procedures to prevent cancer because they are at high risk, and as old as 80, including those returning to improve old or uneven results, have breast reconstruction.

12. Women who make the oldest choice of all _ going without reconstruction _ often say they feel pressured by friends, family and doctors to have reconstruction. Breast cancer surgery and reconstruction decisions are a personal choice.