1. Any plastic surgeon can perform breast reconstruction.
In most U.S. states, any licensed physician can perform plastic surgery, including breast reconstruction. But there are good reasons why you don’t want a hand surgeon or a cosmetic surgeon who rarely (or never) does breast reconstruction to do your procedure. Breast reconstruction is a specialized, artistic endeavor that requires a particular experience and skill. You’re more likely to be satisfied with your results when you choose a board-certified plastic surgeon who frequently performs the procedure you want, and who has a good track record of satisfied patients. Consulting with two or three (or more) reconstructive surgeons is a good idea before choosing one.
2. Reconstruction makes it harder to find a recurring cancer.
Breast reconstruction has no impact on future cancers. Nor does it get in the way of detecting future cancers in the breast. Recurrence is unlikely after mastectomy, but leftover cancer cells can form a small tumor under the skin, near the mastectomy scar or in the little breast tissue that remains. A recurrence in the chest muscle is possible, but is even more unlikely.
3. Breast reconstruction must be done with the mastectomy.
Although there are definite cosmetic advantages to having immediate breast reconstruction with mastectomy, delayed reconstruction can be performed months or even years after mastectomy. Immediate breast reconstruction has many advantages: it decreases visible scarring, saves most of the natural breast skin, and doesn’t require another surgery and recovery down the road to rebuild the breasts. For some women, nipple-sparing mastectomy is also an option; nipples and areola are typically removed if reconstruction is performed at the same time as the mastectomy.
4. Implants are dangerous.
Breast implants carry inherent risks, including capsular contracture, rupture and the need for eventual replacement. But despite being studied more than any other medical device, no scientific study has found that breast implants cause illness. A 2011 FDA advisory identified a very small risk of anaplastic large cell lymphoma, a systemic disease that may occur in the surrounding scar tissue. The estimated risk for women with breast implants is just 60 cases among the 5 – 10 million women worldwide who have saline or silicone implants.
5. Reconstructed breasts don’t look natural.
Breast reconstruction is a highly individual affair, and results are not always the same for every woman. The overall look of the new breasts depends on numerous factors: Your own tissue, the type of reconstruction you have, and most importantly, the expertise of your plastic surgeon. Whether you have implants or use your own tissue, advanced reconstructive techniques can produce new breasts that are symmetrical and look natural. Many women have reconstructed breasts that cannot be distinguished from natural breasts.
6. Reconstructed breasts have no feeling.
During mastectomy, fine nerves beneath the skin that provide most breast sensation are severed when tissue is removed; this typically results in a loss of sensation over much of the front of the breast. Nerves do regenerate, particularly in women who have immediate reconstruction and retain most of their breast skin. The amount of sensation after reconstruction varies widely among women, but most women remain numb in much of the breast. Some feeling usually remains or reoccurs over time in the upper, outer and lower perimeters of the breast.
Women who have natural tissue reconstruction tend to regain more sensation than women who have breast implants, because nerve endings in the chest (if they are not damaged during mastectomy) sometimes spontaneously connect with nerve endings in the flap.
7. Having chemotherapy or radiation for breast cancer delays breast reconstruction.
At one time, patients were routinely advised to delay their reconstruction until their radiation or chemotherapy was completed, but that’s no longer the case for most women. Chemotherapy doesn’t automatically mean you have to wait to have reconstruction, although if you are obese, smoke or have a health condition that threatens healing, your oncologist may recommend that you postpone your reconstruction until you complete your chemo regimen and your white count has recovered enough to have surgery.
Radiation makes breast reconstruction more difficult, but it doesn’t entirely preclude it. Radiation therapy tends degrade the blood flow and elasticity of the remaining chest tissue and muscle—that is why reconstruction with breast implants can be problematic after radiation therapy. (Although some surgeons are having good results by adding an acellular dermal matrix like Alloderm to replace missing breast tissue around the implant. Generally, natural tissue flaps are considered to be a better reconstructive option after radiation therapy.
8. Something always goes wrong.
Any surgery has a potential for complications, and breast reconstruction is no exception. Most women who have breast reconstruction, however, do not experience problems. Serious problems are uncommon, but the risk of infection, a negative reaction to anesthesia, delayed wound healing, excessive bleeding, hematoma, seroma and an unsatisfactory cosmetic result are possibilities. (Another good reason to find a skilled and experienced surgeon for your procedure.)
9. You have to live with your results, even if you don’t like them.
Ideally, your physician’s skill and your honest communication will result in breasts that look the way you want them too. But when that doesn’t happen on the first try, your new breasts can be made bigger, smaller, higher, lower, more symmetrical or better shaped. It often means another short trip to the OR, but most problems can be fixed.
10. Insurance must pay
Federal law requires group health insurance plans that cover mastectomy to also pay for the costs of breast reconstruction, including the cost of procedures needed to produce a symmetrical appearance. The law does not require an insurer to pay for any surgeon or any procedure; an HMO, for example, can still require that you go to an in-network surgeon. (For more info on insurance, see the "Clarifying Your Legal Rights to Breast Reconstruction" blog dated 11/10/2014.)