If you are having a mastectomy, it is important to talk to your breast surgeon about the options for breast reconstruction before your mastectomy surgery and the specialist surgeon that may need to be involved.
Breast reconstruction surgery recreates the shape of the breast following a mastectomy or, occasionally, 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). Breast reconstruction may involve several operations to achieve the final result.
There is much to consider when choosing to undergo breast reconstruction or not after a mastectomy, which we describe in the sections below. Sometimes it may seem overwhelming.
Ask your breast surgeon about referral to a plastic surgeon who specialises in breast reconstructive surgery so that you can fully discuss your options and decide what is the right type of reconstructive surgery for you.
Ask as many questions as you need to in order to understand the options available to you. If you have already had breast cancer surgery, it is not too late to consider breast reconstruction. You can talk to a breast care nurse or your breast surgeon or make an appointment to see a plastic surgeon who specialises in breast reconstructive surgery.
If considering breast reconstruction, research surgery/surgeon, recovery times and possible problems thoroughly beforehand. Talk to people who have had the different procedures performed and ask to see pictures of final results.
You may also consider not having a breast reconstruction after a mastectomy, at all. This is sometimes referred to as “staying flat”. This decision is a personal one and completely yours to make. The most important thing is that you are comfortable with how your body looks and feels. If you think that you want to stay flat, you need to talk with your breast surgeon and/or reconstructive surgeon to ensure the best possible cosmetic outcome.
I had private health insurance, but having said that, we were still out of pocket by more than $12,000.
It’s important to 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 ask your GP or surgeon for a referral to another surgeon.
If you have private health insurance, you can ask your fund what is covered by your insurance and what the gap will be between how much you are charged and how much is paid by your fund. There can be a substantial gap between the cost of surgery and the amount you receive from your insurance fund that is not covered by Medicare.
You can also ask your insurance provider 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 insurer, the surgeon will charge your health fund directly, and there should be no out-of-pocket cost to you.
The different types of breast reconstruction include:
When deciding about breast reconstruction, understanding what to expect in terms of outcomes can be difficult. Keeping in mind the questions below may help you better understand what is reasonable in terms of your outcomes from surgery.
Understanding the options and potential impacts of breast reconstruction after mastectomy can be challenging. Speak with your surgeon and treating team and ask them any questions you may have about breast reconstruction. In addition, BCNA has several resources and tools available to support you (see below).
Breast reconstruction following a mastectomy for breast cancer is available in the public hospital system as well as through the private health system. It is considered a medical procedure, not cosmetic surgery.
There is no charge to you if you have your breast reconstruction through the public health system. If you would like to consider this option, your breast surgeon or breast care nurse can refer you to a public hospital that offers breast reconstruction surgery. Not all public hospitals are able to provide breast reconstruction surgery, and waiting times will vary from hospital to hospital and across different states and territories. You can talk to your treating team about what's available and where you can go to have your preferred procedure.
If you are considering an immediate breast 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 would like to have your surgery in a public hospital and 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. Waiting times can be up to two years or more in some places. Keep in mind that you can “shop around” to find a hospital where the waiting list times may be shorter.
It is possible to put your name on a public hospital waiting list even if you’re not sure that you will want a breast reconstruction. Try to do this as soon as you can. You can then use the waiting time to explore your options and make your decision. If you decide not to have a breast reconstruction, you can remove your name from the waiting list.
You can choose to pay for treatment as a private patient even if you don't have private health insurance. If you choose to have breast reconstruction surgery through the private health system, there can be considerable out-of-pocket expenses, even if you have a high level of private health insurance.
Some people have told BCNA that their out-of-pocket expenses have reached up to $15,000, while others report much less.
I requested details of surgery beforehand and called my health fund to check how much they would cover and if the anaesthetic was covered.
Your breast surgeon may be able to recommend a plastic surgeon, or you can visit the Australian Society of Plastic Surgeons website, which has a tool to help you ‘Find a Surgeon’ in your area, or call 1300 367 446 for a list of surgeons who specialise in breast reconstruction.
BCNA members have provided the following useful tips for other people considering breast reconstruction:
To treat breast cancer, your health team will recommend the best option for you. The right type of surgery depends on a range of factors
Let’s be Upfront about the extra challenges and different needs of LGBTIQ+ people when diagnosed with breast cancer.
Let’s be Upfront about communicating with your health professional.
Planning domestic or international travel? You may need to consider travel insurance, healthcare, medications and more
Councils, health services and volunteers can provide different help, including at home, linking you to financial advisers and social workers
Let’s be Upfront about how to plan for and recover from breast reconstruction surgery.