Breast reconstruction surgery involves the surgical correction of deformities or asymmetries of your breasts after either complete mastectomy or partial mastectomy or lumpectomy. A 1998 Federal law mandates that your health insurance which covers the cancer treatment also cover the surgeries which can help you achieve better symmetry. This means that if you have had a lumpectomy (partial mastectomy) and radiation, and as a result your breasts are not even, then your insurance is mandated to cover the breast lift, breast reduction or even breast augmentation including fat grafting to help your breasts look more similar. This is also true if you have had a complete mastectomy. The reconstructive efforts can start at the same time as your initial cancer treatment. This is called immediate reconstruction. While there are some reconstructive options which limit your surgeries to one or two. It is more usual to have a staged reconstruction involving 3-4 surgeries over the course of 9-12 months. This is more likely if you need your nipple reconstructed. Sometimes however, there can be good reasons to delay reconstruction. This is especially true if you have many other health issues which increase your risk of serious complications. Ask your plastic surgeon about assessing your risk with the risk assessment tool found on www.BRAscore.org.
Oncoplastic breast reconstruction
Many women falsely believe that if they have a lumpectomy and radiation, that they will not need, or are not candidates for, reconstruction. Many are told not to “worry” about that. Being educated about your options is not a worry. Being informed is being empowered to make the right decision for yourself. Newer advances in the treatment of smaller breast cancers, result in a reshaping of your breast at the same time of the cancer lump removal. This is called “oncoplastic” surgery. Oncoplastic surgery applies breast reduction principles to the surgical planning so you would have no scars in the “V” section of your neckline and your scars would be hidden by most clothing and bathing suits. Our experience is that by reshaping the breast immediately after the lumpectomy, there is less chance of a “sunken cupcake” deformity after your radiation. The same federal law that covers breast reconstruction after total mastectomy, covers the surgeries involved to help you to optimize your breast symmetry following lumpectomy and radiation. That means insurance will pay for the breast reduction, lift and augmentation (including fat grafting) that is needed on either side because of your diagnosis of breast cancer.
Fat grafting after breast reconstruction has been used for a couple of decades and recent studies affirm that this does not compromise safety or increase the risk of breast cancer. Fat grafting can revitalize tissue and help it to be more pliable. This is especially helpful after radiation which has the tendency to make tissues more stiff and less pliable. Fat grafting starts with liposuction of which ever area has some extra “fluff”. Then the fat is purified and placed in the areas needed by slender cannulas about the diameter of a coffee stir straw. The incisions for fat harvesting and placement are smaller than the length of a grain of rice. Because of the very small incisions, recovery is usually quick and is helped by wearing a shaping garment for 4-6 weeks following surgery. As this is a grafting procedure, you can anticipate that you will need to have 2-4 procedures staged every 3 months. This is especially true after radiation, which prevents a large volume fat graft. As the tissue is revitalized, then larger volumes of fat grafting are possible. For many women, fat grafting is a perfect way to take from areas where you don’t want fat and place it where is it very desirable. Fat grafting can be used for both reconstruction as well as cosmetic purposes to enhance breasts, face and body areas.
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