Commonly asked questions about reconstructive surgery.

Q I'm scheduled for a mastectomy. When is the best time to have reconstructive surgery?

A When to have reconstructive surgery depends on your own situation. Most women can have immediate reconstructive surgery and wake up with a breast, because we're catching tumors at such an early stage. So in those situations, immediate reconstruction is safe and acceptable and should be offered to the majority of women.

In cases where the tumor is more advanced, and we know for certain that a woman is going to have radiation or prolonged chemotherapy, we sometimes recommend you delay reconstruction until the treatments end, because we don't want to do anything that might interfere with the treatment or vice versa. For instance, radiation therapy could affect the reconstruction, causing an implant to fail prematurely or flap to harden or even shrink a bit.

Q I had a mastectomy 20 years ago but never had reconstruction. Is it too late?

A It's never too late for breast reconstruction, and you're never too old. As long as you're healthy and willing to undergo the operation, you can get great results. In fact, studies in women over 65 find a very high rate of satisfaction.

Q Which is better, a breast implant or a reconstructive flap?

A It really depends on you. For many women, implants are a very good option. It's a shorter operation, a speedier recovery and provides a very good cosmetic result. The downside is that implants won't last forever--studies find that one in three women receiving an implant for reconstruction, regardless of the type (silicone or saline), require another operation within five years. (12), (24)

However, if you've had radiation to the breast area, I recommend avoiding an implant. After radiation, the tissue loses some of its elasticity, making it more difficult to create a natural looking breast.

While the flaps are a more difficult operation with a more prolonged recovery, they last forever and get better with time as the scar tissue softens and the effects of gravity serve to make the breast look more realistic.

Q I don't have health insurance. What are my options for breast reconstruction?

A While the Women's Health and Cancer Rights Act of 1998 requires all health insurance providers who cover mastectomy procedures to also cover the cost of breast cancer reconstruction, there is no such law for women without health insurance. The best I can suggest is to talk to your surgeon and the hospital; sometimes the surgeon will waive the fee for the procedure, and the hospital may offer a discount if you're paying cash.

References

(12) FDA Breast Implant Consumer Handbook. US food and Drug Administration. 2004.

(24) Gabriel SE, Woods JE, O'Fallon WM, et al. Complications leading to surgery after breast implantation. N Engl J Med. 1997;336(10):677-82.

--Maurice Nahabedian, MD, FACS

Georgetown University Hospital

Department of Plastic Surgery

Washington, DC