Breast reconstruction

Breast reconstruction surgery recreates the shape of the breast following a mastectomy or breast conserving surgery. It can be done at the same time as your surgery (immediate reconstruction) or as a separate procedure at a later time, even many years later (delayed reconstruction).

If you think you may be interested in having a reconstruction, you may like to talk to your surgeon about this before you have your breast cancer surgery. You may also like to ask for a referral to a plastic surgeon to discuss your reconstruction options.

If you are unsure whether or not you will want a reconstruction, you can choose to have a temporary tissue expander inserted at the time of your surgery. This can stay in place for 2 to 5 years, giving you time to decide whether or not you want a reconstruction.

If you have already had breast cancer surgery, it is not too late to consider breast reconstruction surgery. You can talk to a breast care nurse or your breast surgeon, or make an appointment to see a plastic or reconstructive surgeon.

It is important to remember that breast reconstruction surgery is aimed at creating a natural shape when you are clothed. Your new breast will not look the same, or feel the same, as the breast you have lost.

Access to breast reconstruction

Breast reconstruction following a mastectomy for breast cancer is considered a medical procedure, not cosmetic surgery. It is available in the public hospital system as well as through the private health system.

Breast reconstruction in a public hospital

Breast reconstruction is available through the public health system at no charge to women. Sometimes women are surprised to learn this - they tell us that no-one told them they could have a breast reconstruction free-of-charge in a public hospital. If you would like to consider this option, your breast surgeon or breast care nurse can refer you to a public hospital that offers reconstruction surgery. Not all public hospitals are able to provide reconstruction surgery.

If you are considering an immediate reconstruction and would like to have your surgery in a public hospital, it is important that you talk to your breast surgeon about this as soon as possible. If you are seeing a surgeon who works only in the private sector, you may need a referral to someone who works in a public hospital.

If you choose to have delayed reconstruction at a public hospital, you will be put on the hospital’s elective surgery waiting list. It is important to understand that there may be a wait for delayed breast reconstruction surgery – up to two years or even longer in some places. In some hospitals, however, waiting list times are much shorter. You may like to ask how long the waiting list time is at the hospital of your choice. Keep in mind that you can ‘shop around’ to find a hospital where the waiting list times are shorter. Your breast care nurse may be able to help you with this.

You can put your name on a public hospital waiting list even if you’re not sure that you will want a reconstruction. It can be a good idea to do this as soon as you can. You can use the waiting time to investigate your options and make your decision. If you decide not to have a reconstruction, you can remove your name from the waiting list.

Breast reconstruction in a private hospital

We know that for some women who have breast reconstruction surgery in the private health system there can be considerable out-of-pocket expenses, even if you have a high level of private health insurance. Some women have told us of out-of-pocket costs of up to $15 000, while for others the out-of-pocket cost is much less.

We suggest you ask your surgeon (and anaesthetist) for a written quote before committing to any surgery. Some specialists are willing to negotiate their fees if you ask them. If you are not happy with the quote you receive, you can shop around for another surgeon/anaesthetist.

If you have private health insurance, you may like to contact your insurance company and ask for the names of any plastic or reconstructive surgeons who have entered into ‘gap cover’ agreements with them. If your surgery is provided by a surgeon who has a ‘gap’ agreement with your fund, the surgeon will charge your health fund directly and there should be no out-of-pocket cost to you.

For more suggestions on accessing breast reconstruction, download a list of tips provided by women who completed BCNA’s 2010 breast reconstruction survey. You can also read the results of BCNA’s Breast Reconstruction Project, which investigated issues around women’s access to breast reconstruction surgery and their satisfaction with the outcomes.

Types of breast reconstruction

Breast reconstruction can be performed using implants, a woman's own tissue, or a combination of both. It is also possible to use tissue from the remaining breast (breast sharing reconstruction).

Implants

Implant reconstruction uses silicone or saline implants which are inserted under the chest muscle onto the chest wall.

The main advantages of implants are:

  • the operation is relatively simple
  • time in hospital and recovery time is usually short
  • surgery and scarring is only in the breast area

The main disadvantages of implants are:

  • the breast may not feel as natural as with other types of reconstruction
  • it can be harder to match the shape of the existing breast
  • if you lose or gain weight, the implant may no longer match your other breast as it will not change size
  • scar tissue can form around the implant

Using your own tissue

Reconstruction using your own skin, fat and muscle is called 'tissue flap reconstruction'. There are two main types of tissue flap reconstruction - 'attached flaps' and 'free flaps'.

Attached flaps use skin, fat and muscle from your back or abdomen. A portion of tissue and muscle is tunnelled under the skin from your back or abdomen to your chest where the new breast is formed.

Free flaps use skin, fat and muscle removed from your abdomen or buttock. The arteries and veins are cut and then attached to the blood supply of the chest wall.

The main advantages of tissue flap reconstruction are:

  • it produces a more natural looking breast
  • the breast will gain and lose weight as your body gains and loses weight

The main disadvantages of tissue flap reconstruction are:

  • the length of surgery and recovery time is longer than with implant surgery
  • you will have a scar on your back or stomach
  • you may lose strength in your stomach muscles if your reconstruction uses abdominal tissue
  • there is a small risk that the flap may die due to lack of blood supply and may need to be removed, requiring another operation

Nipple reconstruction

Nipple reconstruction is optional with a breast reconstruction. There are two ways to make a nipple:

  • using the tissue on the new breast, or
  • a skin graft from another part of the body.

Once the nipple is created, it can be tattooed to give the appearance of an areola and match the colour of the other breast's areola. As the new breast has little or no sensation, the tattooing is usually painless. You can also opt for a nipple prosthesis, which is attached to the breast with special glue.

How can I find a good plastic surgeon?

While breast and general surgeons can insert tissue expanders and perform implant reconstructions, you may need to see a plastic surgeon for a tissue flap reconstruction. Your breast surgeon may be able to recommend a plastic surgeon, or you can visit the Australian Society of Plastic Surgeons website or call 1300 367 446 for a list of surgeons who specialise in breast reconstruction in your state or territory. You may also like to talk to other women who have had reconstructive surgery about their experiences with their surgeon and the results they achieved.

"If considering breast reconstruction, research surgery/surgeon, recovery times and possible problems thoroughly beforehand and talk to women who have had the different procedures performed. Ask to see pictures of final results." --Robin

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