“You don’t have to get reconstruction. It’s completely up to you,” says Amber Buchanan, a certified mastectomy fitter with Expressions of Hope, a Premier Health program that supports women undergoing cancer treatment. “You have to make up your own mind what you feel you can handle, what’s the most comfortable route for you. That’s what we’ll help you with.”
She recommends taking your time to decide. Your cancer outcome won’t be impacted by waiting a week or two.
Types of Reconstructive Surgery
Your surgeon, who performs mastectomies, works closely with plastic surgeons who perform breast reconstruction surgery. Your doctor can help guide you in making the decision that’s right for you.
“Reconstruction surgery can be started at the time of a patient’s mastectomy, or it can be scheduled later to give the patient the time she needs to decide,” says plastic surgeon Dr. Todd Hicks of Premier Physician Network’s Premier Plastic Surgeons.
He adds, “Advances in surgical techniques and equipment have improved patient satisfaction over the past five to 10 years, although, as with any surgery, these procedures have risks, such as infection.”
Reconstructive breast surgery includes:
- Implant surgery, which replaces breast tissue with silicone shells filled with saline solution or gel. This is often a two-step procedure. First, a temporary expander is put in place to stretch your skin. A permanent implant will then be inserted during a second procedure.
- Attached tissue flap, which uses tissue from your upper back or abdomen that remains attached to its blood supply. This tissue is pulled under the skin, positioned on the chest, and shaped to look like a breast.
- Free tissue flap, in which a flap of tissue is entirely cut away from the abdomen (or occasionally the buttocks or thigh) and reattached to the chest area.
After a reconstructed breast heals, another procedure often is performed to reconstruct the nipple and areola, although this also can be done with tattooing.
Significant advances in nipple-sparing mastectomies make it possible to save nipple skin for some women, leaving it intact over the breast implant.
Dr. Hicks says, “I advise patients that the outcome of reconstructive surgery is not immediate. It’s a process that takes time, and it may not initially look like what you may envision. But as you heal, it will look better.”
Insurance and Breast Reconstruction
Under the Women’s Health and Cancer Rights Act of 1998 (WHCRA), insurance policies that cover mastectomy must also cover breast reconstruction. Medicare covers breast reconstruction, although Medicaid coverage varies from state to state.
In the case of unilateral mastectomy, in which one breast is removed, the WHCRA requirement also covers reconstruction of the other breast to produce a symmetrical appearance.
And, says Buchanan, WHCRA applies to prostheses and treatment of physical complications associated with mastectomy, such as lymphedema (swelling, usually in the arms).
Expressions of Hope
As the primary mastectomy garment and prosthetics fitter for Expressions of Hope, Buchanan helps women regain confidence about their appearance and self-image after mastectomy or lumpectomy. “We help women feel more comfortable and confident, to get them feeling normal again. A lot of women come to us because they haven’t felt right since their surgery.
“The women we help have gone through a lot. They’ve had radical surgery, and they go through chemo or radiation, and they don’t feel like themselves. They don’t feel comfortable.”
She and other Expressions of Hope fitters help women who have breast reconstruction surgery and those who choose not to.
Expressions of Hope offers a variety of garments:
- Mastectomy bras that have pockets to hold prosthetics
- Full prosthetics for women who have had mastectomies
- Partial prosthetics for women who have had lumpectomies and want symmetry
- Active forms, or swim forms, to wear while swimming or exercising
- Prosthetics that can be adjusted during the stages of reconstruction
In addition to helping women find the right size, shape, and style of garment to fit their needs, Buchanan says, “we teach our clients how best to wear their garments and how to adjust them as needed during the day.”
Fitting appointments are typically scheduled at least six weeks after a woman’s surgery, “to help provide a proper and comfortable fitting,” Buchanan says. “We want everything to be healed, because your size will change as the post-surgery swelling goes down.”
Expressions of Hope also can schedule appointments before surgery for women who want to see the variety of mastectomy garments available to them. “It can be a little intimidating not to know what to expect before surgery,” Buchanan explains.
Patients need a prescription from the doctor to bill insurance for their garments. “This could be from their oncologist or general practitioner.”
Insurance coverage for mastectomy garments varies, so Expressions of Hope can help patients check their policies. Buchanan adds that patients can buy garments out of pocket if they want more than their insurance will cover.
Expressions of Hope partners with charitable foundations to assist qualified patients with uncovered expenses.
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