What is Breast Reconstruction?
Breast reconstruction is a process of surgical restoration to rebuild the form and appearance of breasts after mastectomy or lumpectomy. There are more advanced procedures available today that aim to preserve as much of the original breast tissue as possible with results that look and feel exceedingly natural. The most common techniques involve either breast implants or a “flap” approach, which utilizes the patient’s own tissue from other areas of the body to recreate the breast mound.
During a consultation, a thorough examination of the tissues and skin will be conducted, and Dr. Hinojosa will take the time to understand each patient’s personal goals and preferences. Breast reconstruction may be performed on one or both breasts at the same time as the cancer removal surgery (immediate reconstruction) or at a later time (delayed reconstruction), depending on the medical needs and individual wishes of the patient.
What Are the Different Types of Breast Reconstruction?
There are several breast reconstruction options available that can be beneficial in restoring a natural-looking breast appearance. Below is an overview of the most common reconstructive techniques, which can be adapted to the needs of each patient:
Breast Reconstruction with Implants
For implant-based breast reconstruction, the patient will select the size and shape they prefer for either silicone or saline breast implant(s). In general, silicone implants tend to have a softer, more natural look and feel, but saline implants offer more customization in terms of sizing. For patients that retain enough healthy breast skin following cancer treatment, implantation may be performed as a single surgery at the same time as the mastectomy—also known as a direct-to-implant procedure. Otherwise, breast implants can be placed using a method called tissue expansion (see below).
Although there are several breast reconstruction options available, patients may be inclined to choose breast implants if they are interested in a shorter recovery, since the healing process is often significantly quicker compared to tissue-based breast reconstruction procedures.
Breast Reconstruction with Tissue Expanders
The tissue expander approach is generally employed when patients do not have sufficient healthy breast skin to accommodate an implant immediately after mastectomy or lumpectomy. Tissue expanders are implant-like devices that are placed in a deflated state. Over time, they are gradually filled with larger volumes of saline via a valve mechanism in order to slowly stretch the remaining breast skin until it reaches the patient’s desired size. Once a sufficient breast pocket has been created, the expanders are removed and Dr. Hinojosa places the patient’s chosen implants.
Latissimus Dorsi Flap Breast Reconstruction
There are various forms of tissue flap breast reconstruction—also known as autologous reconstruction—that are designed to rebuild the breast mound using a patient’s own tissue (“flaps”) and blood supply from another part of the body. More specifically, the latissimus dorsi flap (lat flap) method, transports skin, fat, muscle, and blood vessels from the upper back to the chest through an incision in the underarm. The lat flap procedure may be combined with a breast implant and/or tissue expander for optimal results. Dr. Hinojosa may recommend this option for patients who are undergoing a delayed reconstruction or those who have had radiation therapy, which can compromise the outcomes of implant-only reconstructions. Patients may also prefer flap reconstruction due to the fact that it utilizes natural tissues for a permanent result, as opposed to breast implants, which typically need to be replaced every 10-15 years.
Oncoplastic Breast Reconstruction
For breast cancer patients that undergo a lumpectomy or partial mastectomy—in which only a portion of the breast tissue is removed—oncoplastic breast reconstruction may be indicated. Oncoplastic breast reconstruction utilizes a patient’s healthy breast tissue to fill and reform the area affected by tumor removal to shape a more natural breast appearance. It is done at the same time as the cancer surgery and typically involves greater collaboration between the oncologist and plastic surgeon. Oncoplastic reconstruction offers an aesthetic alternative to traditional breast cancer surgeries, focusing on both oncological safety and cosmetic outcomes. Ir can be a good option for many patients undergoing breast-conserving surgery.
When Is the Best Time for Breast Reconstruction?
In general, the timing for breast reconstruction varies based on the individual’s plans for cancer treatment. Typically, patients often find the most effective results are achieved when reconstruction is done sooner rather than later, if possible. The most appropriate timeline will be discussed between the patient, their oncologist, and their plastic surgeon. If a patient opts to begin breast reconstruction at the time of their mastectomy or lumpectomy, that is known as “immediate breast reconstruction.” Alternatively, the procedure(s) may be performed at a later date, referred to as “delayed breast reconstruction.”
Some of the factors that should be taken into consideration include the stage and type of breast cancer, the potential for follow-up radiation or chemotherapy, other medical conditions (diabetes, circulatory problems, or a bleeding/clotting disorder), metastatic or inflammatory breast cancer cases, and personal preferences. For patients experiencing severe emotional stress, it might be best to hold off on deciding until they feel ready to move forward in the process. With that said, Dr. Hinojosa recommends learning about the available breast reconstruction options to be prepared and informed once the time is appropriate.
Is Breast Reconstruction Covered by Insurance?
Breast reconstruction is typically covered by insurance, as mandated by the Women’s Health and Cancer Rights Act (WHCRA) of 1998. This law requires most health insurance plans to cover reconstruction following a mastectomy, including procedures on the opposite breast for symmetry. That said, the type and degree of coverage may vary, so it’s essential to check with your insurance provider for specific details and requirements. Our team is happy to help you navigate the insurance process.
Schedule a Consultation
Ready to schedule a consultation with Dr. Hinojosa? Contact the Coastal Cosmetic and Plastic Surgery Center today.
