Post-mastectomy breast reconstruction: The importance of awareness –– Physicians' Clinic of Iowa

Post-mastectomy breast reconstruction: The importance of awareness –– Physicians’ Clinic of Iowa

By Dr. Kahlil Andrews, Plastic & Reconstructive Surgeon, Physicians’ Clinic of Iowa, Linn County LIVING WELL Magazine

A diagnosis of breast cancer can be a very emotionally overwhelming experience. Add to that the mountain of information you receive from medical and radiation oncologists, breast surgeons, medical geneticists, and plastic and reconstructive surgeons and it’s likely your head is spinning.  For those feeling “information overload,” here’s what you need to know post-mastectomy.

Studies show that breast reconstruction after mastectomy is associated with a variety of benefits. There are positive effects on psychological health, self-esteem, sexuality, body image, and reduced concerns for cancer recurrence.[1] With so many encouraging benefits, it is important that patients and healthcare professionals alike be well informed regarding the different types of breast reconstruction and associated factors.

Timing—When is the best time to have reconstructive breast surgery?

When reconstruction is begun at the time of the mastectomy it is termed immediate reconstruction. If a woman waits until after the mastectomy incision and tissues have healed and then returns for reconstruction months later, it is termed delayed reconstruction.

Delayed reconstruction is typically performed for those who require post-mastectomy cancer treatments. In these cases, reconstruction is postponed until after that care has concluded. Delayed reconstruction is shown to have fewer post-operative complications and is thus recommended for individuals who are at increased risk for post-mastectomy issues.

Many patients and breast surgeons prefer immediate reconstruction. Waking from a mastectomy with a fully or partially reconstructed breast has emotional and psychological benefits. In addition, it can eliminate a step in the reconstruction process. A distinct benefit of immediate reconstruction is that it is associated with improved cosmetic outcomes when compared with delayed reconstruction. However, because it is associated with a higher complication rate, immediate reconstruction should only be offered to carefully selected patients. Certain women of advanced age, poorly managed diabetics, smokers, and those with an elevated body mass index should be strongly encouraged to have delayed reconstruction.

Surgical Approach—What type of reconstructive surgery is right for me?

Most women have what is termed a skin-sparing mastectomy—where the breast tissue and nipple are removed, but the breast skin envelope is maintained. Preserving the skin is vital to recreating a natural looking breast. With the breast envelop intact, the task is replacing breast volume. Volume can be replaced in two ways—either with a breast implant or with the individual’s own tissue, termed a flap procedure.

Implant reconstruction most commonly occurs in two stages. During the first stage, a device called a tissue expander is placed. The expander is slowly inflated over a couple of months in order to create a space for the permanent implant. During the second stage (usually three to four months later) a silicone or saline implant is placed. The tissue expander can be inserted either at the time of the mastectomy (immediate reconstruction) or several months after the mastectomy is performed (delayed reconstruction.)

With flap reconstruction, tissue from the lower abdomen, back, buttock or inner thigh is used to recreate breast volume. When a woman’s own tissue is used, the reconstructed breast often has a more natural look and shape. While a flap procedure is a longer surgery than implant reconstruction, there is the opportunity to complete the mastectomy and reconstruction with a single procedure versus two separate procedures with implants. The flap procedure can either be done at the time of the mastectomy or several months after the mastectomy is performed.

Insurance Coverage—Can I afford breast reconstruction surgery?

There is often a lack of understanding surrounding the insurance coverage for post-mastectomy reconstruction. In 1998 Bill Clinton signed the Women’s Health and Cancer Rights Act (WHCRA) into law.[2] It mandates that all insurance companies that offer mastectomy coverage also offer post-mastectomy reconstruction coverage. Under the law, procedures on the opposite breast must be covered to achieve symmetry as well as complications associated with mastectomy.

Procedures to lift, augment, or reduce the size of the unaffected breast to achieve symmetry with the reconstructed breast are often covered by insurance. Although coverage is mandated, the law does not specify the amount of coverage that must be offered to beneficiaries. It is important that women contact their insurance company to inquire about their level of coverage.

Physicians’ Clinic of Iowa tailors our breast care to each woman’s specific situation. If you’d like more information on post-mastectomy reconstruction, call 319-362-5118 and speak with Dr. Andrews or a member of his team today. We can discuss the options available and find the right solution for you.



[1] Prospective Analysis of Long-term Psychosocial Outcomes in Breast Reconstruction: Two-year Postoperative Results From the Michigan Breast Reconstruction Outcomes Study; Ann Surg 2008; 247: 1019–1028

[2] The WHCRA of 1998: Is the Federal Law Mandating Breast Reconstruction Coverage Working? Plastic Surgery News, American Society of Plastic Surgeons. September, 2012