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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 accomplished with little or 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 its coverage: it may pay only for reconstruction with in-network surgeons, for example, and restrict coverage
to the types of reconstruction those surgeons provide. For more information, see Chapter 7: Searching for Answers.
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,
thighs, hips 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 more uncomfortable than implant reconstruction, however, 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 rebuilt. 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. If you have a nipple-sparing
mastectomy, you will have your own natural nipples on your reconstructed breast. For more information, see Chapter
14: Final Touches: Creating the Nipple and Areola.
Q: Can I keep my own nipples?
A: Many women can, especially if you are having preventive
mastectomy. If your mastectomy is scheduled to treat a diagnosis of breast cancer, you might still be able to keep your own
nipples if you meet certain criteria - if your cancer is a safe distance away from your nipple, for example. Your nipples
may not look the same or retain full sensation after nipple-sparing mastectomy. For more information, see Chapter
4: How Mastectomy Affects Reconstruction. 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. If you're interested in Direct-to-Implant or
tissue flaps that don't use muscle, use this website's list of surgeons (see the menu on the left). For more
information, see Chapter 6: Finding Dr. Right.
Q: Will radiation affect my
reconstruction?
A: It may, but to what degree it will 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 most 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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