Reconstructive surgery or prosthesis?

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Reconstructive surgery or prosthesis?

You can have reconstruction at the time of your
mastectomy or wait to have reconstruction at a later
date. You might decide that you do not want any more
surgery. If this is the case, you have another choice to
make: whether or not to use a breast prosthesis. Here
are a few things to consider when making the choice:
• Are you comfortable with the way your chest looks
after surgery? If so, you may not want reconstructive
surgery.
• If you do not want to do anything permanent, but
want to maintain a balanced look when you are
dressed, a prosthesis may be a better choice for you.
• Are you willing to have a second surgery? Do you
have any concerns about reconstruction procedures?

You do not have to make a decision right away. Talk
with other women who have had reconstruction or
have chosen to use prostheses. It is never too late to
try prostheses or to have reconstructive surgery.

If you choose to use a prosthesis
A prosthesis is an artificial, flexible breast
form that you can put on or take off whenever
you want. Prostheses come in many shapes,
sizes, materials and colors. A member of your
health care team can suggest nearby places
where you can buy prostheses. Many specialty
stores that sell medical supplies carry them, as
do some larger department stores that have
sales staff who work with women who have
had mastectomies.
• Before you go, call ahead for an appointment
so you do not have to wait.
• Wear a form-fitting top. Wear the prosthesis
around the store for 30 minutes or more to
get the feel of it.
• Try on different ready-made prostheses and
decide which one is the best match for your
remaining breast. If you have had a double
mastectomy, you can buy two matching
prostheses.
• You can also have a prosthesis custom-made.
These are more expensive than the ready-made
version, but sometimes provide a better match.
• Find out what your insurance will cover.
Most plans will pay for a reasonably priced
new prosthesis every two years.

If you choose to have breast reconstruction
Breast reconstruction is surgery to recreate a
missing breast. It is a replacement for the lost
breast, and can include a reconstructed nipple.
If you have decided to have reconstructive surgery,
follow these steps:

STEP 1 — Ask your doctor to refer you to
a plastic surgeon who is an expert in breast
reconstructive surgery. This is especially important
if you choose to have the reconstructive
surgery at the same time as the mastectomy.

STEP 2 — Talk with the plastic surgeon and find
out about his or her skills and experience. The
surgeon you choose should ask questions, listen to
your answers carefully and make a recommendation
about the best surgery for you. If you have concerns,
get a second opinion.

STEP 3 — Find out what your health insurance
will cover. Know and understand your rights.
• The Women’s Health and Cancer Rights Act
(WHCRA) provides protections for women who
choose breast reconstruction with a mastectomy.

STEP 4 — Decide if you want the reconstructive
surgery right away (with mastectomy) or later.
It is never too late to have this surgery.

Types of reconstructive surgery

As you talk with your doctor about which surgery
would be best for you, remember to ask about the
recovery time and any pain or scarring that may occur
from surgery. It is also important to discuss how a
plan for radiation therapy may impact the decision
for reconstructive surgery.

Flap procedures — In these procedures, your own
tissue is used to recreate a breast. These surgeries take
the longest to complete and have a higher risk of a
complication. However, because they use your own
skin, muscle and fat, the reconstructed breast will
more closely reflect your bodily changes like gaining
or losing weight and aging. Three types of flap
procedures are described here:

• The TRAM flap (Transverse Rectus Abdominous
Muscle) is the most common choice. Tissue is taken
from your abdomen and slid up a tunnel under the
skin to your breast area.

• The latissimus dorsi procedure takes tissue from the
shoulder area of your back. This too is taken in a
tunnel under the skin to the breast area.

• The free flap reconstruction uses tissue from the
buttocks or abdomen and is transplanted to the
breast area. This procedure is more complex and
has an increased risk of surgical complications.
Examples of the free flap surgery are the DIEP flap
and S-GAP procedures.

If desired, nipple and areola reconstruction can be
done after any type of reconstructive surgery. This
procedure is usually done at least two months after
breast reconstruction to allow for correct positioning
of the nipple.

If a woman is having breast reconstruction immediately
after her mastectomy, the breast surgeon may
attempt to keep intact as much of the skin of the
breast as possible. This skin can then be used to cover
a tissue flap or artificial implant.

Implants — The implant is the best choice for women
who do not want a flap procedure and involves the
least amount of surgery. An implant can be filled with
saline (salt water) or silicone gel. It is placed under the
chest muscle through an incision made by the surgeon.
Breast implants may need to be replaced at some time
in the future.

Tissue expansion — This technique is used to stretch
the skin to make room for a permanent implant. A
small, balloon-like bag is inserted under the chest wall.
It is expanded by adding saline regularly over weeks or
months until the breast area is expanded to the desired
size. The expander is removed and a saline or silicone
gel-filled implant is inserted.

©2008 Susan G. Komen for the Cure. Item No. 806-395a 7/09