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Q: I had a mastectomy five years ago; can I still have reconstruction?
A: Yes! Reconstruction can be done at any time: immediately after mastectomy, while you're still asleep on the
operating table, or months, or even years later. For more information, see Chapter 4: How Mastectomy Affects Reconstruction.
Q: How prominent will my scars be?
A: Every woman's reconstruction is different. Your reconstruction scars depend largely on how your mastectomy is
performed, and when and how your reconstruction is done. Immediate reconstruction (performed at the same time as mastectomy)
can often be done with almost no visible scarring, while a delayed reconstruction (done months or years after mastectomy)
leaves a pronounced scar across the reconstructed breast. For more information, see Chapter 4: How Mastectomy Affects Reconstruction.
Q: I'm having a prophylactic mastectomy; can I still have reconstruction?
A: Yes! Just about any woman who has a mastectomy, whether for cancer treatment or to reduce her risk of developing
breast cancer, can have reconstruction. Anyone considering prophylactic mastectomy can benefit from genetic counseling to
identify and understand her actual risk of developing the disease. For more information, see Chapter 5: Considering Prophylactic
Mastectomy.
Q: Will my insurance pay for my reconstruction?
A: In many cases, yes. By law, health insurers who pay for mastectomy must pay for reconstruction. Not all insurers
pay for mastectomy, however. An insurance company may impose restrictions on coverage; it may pay for a breast prosthesis
or reconstruction after mastectomy, for example, but not both. For more information, see Chapter 7: Searching for Answers.
Q: Can I have an implant put in right after mastectomy?
A: Yes, if you will have immediate reconstruction and want a very small breast reconstructed. Most women, however,
will need to go through an expansion process first. An implant-like device called an expander is placed under the skin at
the mastectomy site and gradually inflated with saline over six to eight weeks. When the breast skin has been stretched sufficiently,
the expander is replaced with an implant. For more information, see Chapters 9 and 10: Breast Implants and The Expander
Experience.
Q: What if I don't want an implant?
A: Breast reconstruction can also be accomplished with a tissue flap, which uses skin, fat and sometimes muscle
from elsewhere on the body (abdomen or back, for example). For more information, see Chapters 11 and 12: Tummy Tuck Flaps
and Other Flap Methods.
Q: How painful is reconstruction and recovery?
A: This depends on the individual, the type of reconstruction performed, the surgeon's skill and many other factors.
Generally, recovery from tissue flap surgery is much more uncomfortable than implant reconstruction. Discomfort during recovery
is controlled with pain medication. For more information, see Chapters 9-12: Reconstructive Procedures, Chapter 16: In
the Hospital, and Chapter 17: Back Home.
Q: How closely will my reconstructed breast match my healthy breast?
A: A very close match can often be achieved. Some women have their opposite healthy breast altered (augmented,
reduced or lifted) to get a better match. For more information, see Chapter 13: Altering the Opposite Breast.
Q: Will I have a nipple after reconstruction?
A: In most cases, the nipple and areola are removed during mastectomy as a precaution against leaving lingering
cancer cells behind. Once the new breast is created, a nipple and areola can be easily built. The nipple is often created
from a flap of skin from the breast. The areola is made with a small skin graft or simply tattooed. For more information,see
Chapter 14: Final Touches: Creating the Nipple and Areola.
Q: How do I find a good surgeon?
A: Ask for referrals from your oncologist, breast surgeon, friends, or other women who have had reconstruction.
Your local breast cancer organization can also help. Check with the American Society of Plastic Surgeons to be sure the surgeon
is certified, and always seek a second (or third) opinion. Ask each surgeon for referrals to previous patients. For more
information, see Chapter 6: Finding Dr. Right.
Q: Will radiation affect my reconstruction?
A: It may, but to what degree depends on your breast skin and tissue that has been irradiated and the type of reconstruction
you have. Because radiation impairs blood circulation and elasticity in the skin, it often compromises implant reconstruction.
While not ideal, reconstruction with implants produces better results when performed before radiation. Tissue flap reconstruction
produces better results when performed after reconstruction. For more information, see Chapter 4: How Mastectomy Affects
Reconstruction.
Q: Will I have to delay my reconstruction until my chemotherapy treatments are over?
A: The timing of reconstruction when adjuvant (after surgery) treatment is recommended is decided on an individual
basis. Doctors used to routinely recommend delaying reconstruction until chemotherapy was completed. Now, in almost all cases
involving adjuvant therapy, an expander or implant can be placed at the time of mastectomy, then completed after chemotherapy
is finished. Flap reconstruction may be delayed, particularly if you need to begin chemotherapy as soon as possible. For
more information: See Chapter 4: How Mastectomy Affects Reconstruction.
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