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Breast reconstruction

If you have had a mastectomy, you may like to talk to your surgeon about the options for breast reconstruction.

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).

There are many different options available for reconstruction and much to consider so it can seem overwhelming. You may like to ask for a referral to a plastic surgeon to discuss what is best for you and connect with other women who have had a reconstruction. Ask as many questions as you need to in order to understand the recommendations being made for you.

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

You should have time to consider your options before your breast cancer surgery. 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. More information about tissue expanders are below

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 or reconstructive surgeon.

Breast reconstruction can take several procedures over many months to achieve the final result. Depending on the size and shape of your breasts, you may also need to have surgery to your non-affected breast at some point to correct their symmetry. You may like to ask your surgeon what this will cost.

It is important to remember that the aim of breast reconstruction surgery is to create a natural shape when you are clothed -- your new breast will not look the same, or feel the same, as the breast you have had removed.

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Access to breast reconstruction

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.

Breast reconstruction in a public hospital

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 reconstruction surgery. Not all public hospitals are able to provide 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 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.  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 are 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 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 reconstruction, you can remove your name from the waiting list.

Breast reconstruction in a private hospital

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 women have told us that their out-of-pocket expenses have reached up to $15,000, while others report much less.

"I had private health insurance, but having said that, we were still out of pocket by more than $12,000." -- Lyn

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 may like to 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 fund 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.

"I requested details of surgery beforehand and called my health fund to check how much they would cover and if the anaesthetic was covered." -- Sharon

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Tissue expanders

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 is a balloon-like device inserted between the chest muscle and your skin. The purpose of a tissue expander is to gradually inflate and stretch the skin so that there is room for a breast implant after surgery. Tissue expanders can stay in place for up 18 months and give you time to decide whether or not you want to have a reconstruction.

There are different types of tissue expanders. The traditional tissue expander has a port in it that allows your surgeon to inject saline (salt water) into the expander, filling it up over a period of time (between 2 to 6 months) and gradually stretching the skin. This process requires repeated visits to your surgeon to fill it.

In recent years, a new type of tissue expander has become available in Australia that does not require saline injections and repeated visits to a doctor. This tissue expander enables women to control the process at home, using a specially programmed remote control system which gradually fills the tissue expander with a gas-based filler.

If you would like more information on tissue expanders, you can talk to your breast surgeon or breast care nurse.

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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. This is called a breast sharing reconstruction.

Implants

Implant reconstruction typically uses silicone or saline implants. These implants are inserted under the chest muscle onto the chest wall. The main advantages of implants are:

  • it is a relatively simple operation
  • it involves a short stay in hospital and fast recovery time
  • surgery and scarring is only in the breast area.

The main disadvantages of implants are:

  • the breast may not feel as natural as it would with other types of reconstruction options
  • 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. These are ‘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:

  • it requires longer surgery and recovery time
  • 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; if this happens it may need to be removed and another operation may be required.

Nipple reconstruction

Nipple reconstruction is optional after a breast reconstruction. Some women are happy with the look of their new breast without a nipple, while others prefer to have the look of a nipple. There are two ways to make a nipple:

  1. using the tissue on the new breast, or
  2. using 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.

Some public hospitals offer a free nipple tattooing service.

If you have had your breast reconstruction in the private health system, your breast reconstruction surgeon may provide tattooing in her/his practice or may be able to refer you to someone else. There is a Medicare rebate for nipple tattooing, however to receive a rebate your tattooing will need to be done by a health professional who has a Medicare provider number. It is a good idea to check before you make your appointment about any out-of-pocket costs for your tattooing. You may also like to call your private health insurance fund, if you have one, to ask if they will cover it. If you don’t want to make a new nipple but would like the look of a nipple, you can opt for a nipple prosthesis, which is attached to the breast with special glue. Your surgeon or breast care nurse will be able to give you more information about nipple prostheses.

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Useful tips if you are considering reconstruction

BCNA members have provided the following useful tips for other women considering breast reconstruction:

  • If you are unsure if breast reconstruction is right for you, you can use our free breast reconstruction decision aid BRECONDA
  • Join BCNA's online network and connect with women in the Choosing breast reconstruction online group. You will hear from women who have shared their breast reconstruction experience through words and pictures.
  • Ask for referrals to more than one breast reconstructive surgeon so you can find one with whom you feel comfortable and confident.
  • Get more than one quote - charges can vary considerably from surgeon to surgeon.
  • Ask whether an immediate reconstruction (i.e. at the time of your breast cancer surgery) may be appropriate for you.
  • Ask lots of questions and ask to see photos of the surgeon's previous breast reconstruction surgeries.
  • Talk to other health professionals, such as a breast care nurse, about breast reconstruction and any concerns you have.

Finding a surgeon

Breast surgeons and general surgeons can insert tissue expanders and perform implant reconstructions. If you are interested in a tissue flap reconstruction, you may need to see a plastic surgeon. 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.

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More information

These BCNA resources may be helpful if you are considering breast reconstruction: 

For further information on breast reconstruction, you may like to access the following websites and resources: 

  • Visit the Reclaim Your Curves website for support and information about breast reconstruction from women who have travelled the path of reconstruction. 
  • The Cancer Council’s Understanding breast prostheses and reconstruction booklet provides comprehensive information on breast prostheses and breast reconstruction. You can download the booklet or order a copy here
  • Cancer Australia’s website includes comprehensive information for women considering breast reconstruction after a mastectomy. 
  • The Westmead Breast Cancer Institute has a Breast reconstruction brochure you can download here. 
  • Download or order Cancer Council Victoria's Breast: Understanding Breast Prostheses and Reconstruction booklet here