Breast reconstruction is an important decision for those looking to restore the shape and appearance of their breasts after a lumpectomy, mastectomy, or prophylactic mastectomy. This procedure can significantly impact your physical and emotional well-being, so finding the right surgeon is crucial. Read on to learn more about the procedure, including its types, aftercare, and tips for finding the right specialist. 

1. Types of breast reconstruction

Patients typically choose between two main types of breast reconstruction: implant-based reconstruction and flap reconstruction.

  • Implant-Based Reconstruction: This method uses breast implants to recreate the breast shape. Implants are a popular choice but come with the need for ongoing monitoring. Over time, implants may require replacement or additional surgeries, typically within ten years of the initial procedure.
  • Flap Reconstruction: This method uses tissue from another part of the patient's body, often the abdomen, to reconstruct the breast. One of the benefits of flap reconstruction is that, since it uses your tissue, additional surgeries are usually unnecessary unless a revision is desired.

2. Finding the best plastic surgeon for you

Choosing the right surgeon is essential for a successful breast reconstruction. Here are some key factors to consider:

  • Board Certification: Ensure that your surgeon is explicitly board-certified in plastic surgery. This certification indicates they have undergone the necessary training and passed rigorous exams. Be cautious of surgeons claiming to be "board-certified" without specifying their certification in plastic surgery.
  • Experience and Specialization: Look for a surgeon who regularly performs breast reconstruction surgeries, particularly for breast cancer patients. A surgeon who specializes in this area will have more experience and be better equipped to handle the complexities of the procedure.
  • Communication and Transparency: Your surgeon should listen to your concerns and answer your questions thoroughly. If you feel rushed or unheard, it may be a sign to look for another surgeon. Additionally, transparency is crucial—your surgeon should provide realistic expectations, especially if you have undergone treatments like radiation that could affect the outcome.
  • Portfolio of Work: While it's common for surgeons to showcase their best work, asking about less successful cases and the potential challenges you might face is also essential. This honesty helps set realistic expectations.

3. Insurance coverage for breast reconstruction

The good news is that most insurance companies cover breast reconstruction surgery. Advocacy efforts have made it possible for women with breast cancer to have this procedure covered, even if they haven't undergone a mastectomy. For example, insurance may cover reconstruction after a lumpectomy or even a breast reduction if you prefer.

4. Timing of reconstructive surgery: now or later?

Breast reconstruction can be performed immediately after a mastectomy or delayed until later. The choice depends on several factors, including your overall health, the stage of cancer, and personal preference.

  • Immediate Reconstruction: This option is appealing because it combines the mastectomy and reconstruction in one surgery. However, it may not be suitable for everyone, particularly those with other health conditions that could complicate recovery, such as high BMI, use of blood thinners, or smoking.
  • Delayed Reconstruction: Many patients opt to wait for reconstruction, which can reduce risks associated with immediate surgery. This delay allows for a more thorough recovery from cancer treatment and may provide the opportunity to benefit from advancements in reconstructive techniques. However, waiting means you'll need to undergo another surgery in the future.

The duration of surgery is similar whether done immediately or delayed. Implant-based procedures typically take 4 to 6 hours, while flap reconstruction can take 8 to 12 hours.

5. Recovery and aftercare

Recovery time varies depending on the type of reconstruction you choose:

  • Implant-Based Reconstruction: Expect a recovery period of about four weeks. This is generally less intensive than flap reconstruction.
  • Flap Reconstruction: Recovery is more extensive, typically lasting 8 to 12 weeks. Because this method involves using your tissue, it requires more time for the body to heal.

6. Is breast reconstruction necessary?

Breast reconstruction is a personal choice and is not necessary for everyone. Some women are content with going flat after a mastectomy and choose not to have reconstruction at all. A study conducted in 2021 found that 74% of women who decided not to undergo reconstructive surgery were satisfied with their decision. Going flat is a valid option, and you should not feel pressured to undergo reconstruction unless it’s something you genuinely want.