Appropriate surgical interventions for breast reconstruction

How will my nipple and areola be reconstructed?

Nipple and areola reconstruction is the final phase of breast reconstruction. The nipple and areola are most often reconstructed in a secondary procedure that may be performed in your cosmetic surgeon’s office or in an operating room. There are cases were the nipple is reconstructed at the time of initial breast reconstruction, although this is less common. In order to create the projection of the nipple, small, localized skin flaps at the nipple site are elevated and sutured together. Incisions used to create the flaps will result in a scar that is hidden at the base of the nipple or in the region of the areola. In other cases, your plastic surgeon may take grafts of skin from the abdomen or inner thigh to reconstruct the areola. Here, the scars that result from attaching the grafts are concealed at the base of the nipple and outer border of the new areola. Reconstruction of the areola (the darker pigmented skin surrounding the nipple) is achieved through grafting as noted above and/or specialized tattooing techniques. Your cosmetic surgeon will likely refer you to a medical tattoo specialist, or have a resource in his or her office to provide you this service.

What are my rights for coverage of breast reconstruction?

Most women do not know-and often are not told- that insurance companies are required by law to cover any procedures of breast reconstruction and ablative surgery (partial or full mastectomy). This includes procedures determined by your cosmetic surgeon to achieve symmetry between the breasts following lumpectomy, mastectomy, or reconstruction. The enactment of this law is directly a result of the patient advocacy efforts led by the American Society of Cosmetic Surgeons that not only mandated coverage for breast reconstruction, but also for additional procedures on the opposite breast necessary for achieving symmetry. Today, any woman who undergoes mastectomy is entitled to coverage for reconstruction by her insurer. Pre-certification may be required, and your surgeon’s office will provide the documentation necessary for coverage or assist you in filing for insurance coverage.

Will my reconstructed breast match my other breast?

Part of the reconstruction consultation and your plastic surgeon’s expertise includes evaluating the best reconstruction techniques for your individual circumstances, including the shape, size, and position of your opposite breast. Symmetry is a factor; however, it remains possible that your reconstructed breast will not match your other breast. Breast reconstruction using an implant often results in a higher, firmer, more rounded breast compared to your natural breast. Breast reconstruction using flap surgery results in a softer, more natural breast than an implant, but still may never exactly match your natural breast. Symmetry to your opposite breast should not be a concern or consideration to deter you from a recommended reconstruction procedure or from reconstruction in general. In your evaluation for reconstruction, your plastic surgeon will be able to tell you if surgery to the opposite breast would help you to achieve better symmetry. These procedures include:

Mastopexy (breast lift) to raise and reshape a flat, sagging breast
Reduction mammaplasty (breast reduction) to reduce the size of a large breast
Augmentation mammaplasty (breast augmentation) to enhance the size of the breast by placing an implant

You may choose to have these secondary procedures performed at the time of reconstruction, or at a later date. No matter your choice, the same laws that require your insurer to cover breast reconstruction also require coverage of procedures prescribed to achieve symmetry.

What if I choose not to undergo breast reconstruction?

Breast reconstruction is entirely your choice. In many cases, the timing for reconstruction is your choice, too. Don’t make your decision until you have had the opportunity to weigh all of your options, including the option not to have reconstruction. There are alternatives to breast reconstruction; however, there is no alternative to surgical reconstruction of the breast that allows a woman to have a breast that is part of the body. An external prosthesis is a nonsurgical alternative held in place by an undergarment. It is not part of a woman’s body. This type of prosthesis may be uncomfortable and prevent a woman from wearing certain kinds of clothing. In addition, you may choose simply to live with the figure you have. That is entirely your choice. But know that in order to make a fully informed decision, you must be educated about all of your options. Take the time to consult with a cosmetic surgeon and consider breast reconstruction. It is your right, your personal self-image, and your satisfaction that can lead you to feel whole again. According to a study reported by the American Cancer Society in November 2000, which was led by researchers at the University of Michigan, "Women who have breast reconstruction after a mastectomy report significant psychological and emotional benefits."Timing of breast reconstruction was reported to affect those benefits; however, the techniques used- with or without placement of a breast implant-did not appear to make much of a difference in a woman’s level of satisfaction.

1. Tissue expansion and the use of breast implants
What is tissue expansion? Tissue expansion is a means to reconstruct the breast using a breast implant without a flap, where enough healthy skin and soft tiss...

2. What is a pedicled TRAM flap reconstruction
A pedicled TRAM (transverse rectus abdominus musculocutaneous) flap reconstructs a woman’s breast using a flap of skin, fat, and muscle taken from a woman&rsquo...

3. What can I expect during and after the breast reduction surgery
Breast reduction is surgery that removes excess fat, skin, and glandular tissue to reduce breast size and reshape overly large breasts. The weight of overly large breas...

4. Surgical procedures for permanent enlargement of the breasts
How can my breasts be enlarged? The most common way to permanently enlarge the size of your breasts is through the surgical placement of a breast implant, cal...

5. Before undergoing breast augmentation surgery talk to surgery
Before you actually have surgery, you can expect to feel some anxiety, some excitement, and some stress. But the most important thing to do is be confident in your de...

6. What benefits breast augmentation brings
Is breast augmentation covered by insurance? Breast augmentation is an aesthetic procedure. The only consideration for insurance coverage is to achieve symmet...

7. Facts about cosmetic breast surgery and the ways this is performed
Are any breast surgeries commonly performed together? Every breast procedure can be performed in combination with another. Breast lift and breast augmentation ...

8. Results of breast surgery are visible immediatley
When will I see the results of my breast surgery? Nearly every breast surgery, except for reconstruction techniques using tissue expansion, result in immediate ...

9. Women usually undergo breast surgery more than once
Can breast surgery procedures be repeated? A woman’s body, her life, and her personal preferences change over time. These reasons alone are why many wom...