Key Facts for Previvors about Breast Cancer Surgery, Reconstruction



By Patricia Anstett, “Breast Cancer Surgery and Reconstruction: What’s Right for You.” Published June, 2016, Rowman and Littlefield. Web site:

Available at;, some Barnes & Noble stores and some public libraries. Ask your BN store and library to carry it.


  1. Plastic surgeons that do facelifts, nose jobs and wrinkle removal often do not have enough experience to do breast reconstruction. Even among board-certified plastic surgeons, some do not have experience and training to do the latest procedures or may offer ones abandoned by top centers.
  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 by health insurance after a mastectomy. But many states and health plans are exempt. Your health insurance also may limit what doctors you can see. It’s important to ask what your insurance covers and what your out-of-pocket expenses will be.
  4.  Busty or larger-framed women have fewer breast reconstruction choices and poorer outcomes, studies show, and 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.
  5. 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.
  6. One in 10 women choose autologous reconstruction with their own tissue. Only a small 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.
  7.  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.
  8.  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. Most women say they lose sensation in the nipple after breast reconstruction.
  9.  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. As much as a third of a top doctor’s practice may involve these revision procedures.

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