Women opting to have reconstruction need to have a detailed discussion with their surgeons with regard to the risks and benefits of reconstruction. They need to understand that if they are considering reconstruction to maintain their body image that the reconstructed breast will not look exactly like their natural breast.
Women need to know that:
- A reconstructed breast will not have the same sensation and feel as the breast it replaces.
- Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy.
- Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.
- If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts.
- The process of reconstruction may take more than one surgery.
Once a woman has this information, then and only then can she make a decision whether or not to have reconstruction, and to decide which type of surgery she would prefer to have. She needs to decide whether to have immediate reconstruction or delay reconstruction.
Far too many women don’t even get to make a choice. They don’t know they have a choice. Unfortunately, many women are not told about their option for reconstruction at the time they meet with their surgeon.
In states where it is the law to inform women of their right to reconstructive surgery, this is usually not the case. When I chose to have a bilateral mastectomy, it seemed that every member of my care team asked if I wanted to speak with a plastic surgeon about my reconstruction options.
There is conflicting information coming out from recent studies about who is getting reconstruction. One study found that the decision to get immediate breast reconstruction rather than delayed reconstruction or avoiding reconstruction altogether has been related to patient demographics. Immediate reconstruction was more likely to happen in the younger (less than 50 years) white patient who was seeking medical care in an urban versus a rural hospital. These patients were also more likely to be educated, employed, and married. Recently there has been an increase in breast reconstruction among older patients (greater than 65 years), probably related to greater awareness and changes in the attitude of providers.
Patient insurance is another factor in determining if a woman can get immediate reconstruction or delayed reconstruction. Private health care plans provide coverage for reconstruction. Medicare, a federally funded government health program has standard coverage for reconstruction. Medicaid however, is state funded and reconstruction coverage can vary from state to state.
Another issue women face who are covered under Medicaid or Medicare is finding a plastic surgeon who accepts these insurance plans for reconstruction procedures.
Given the trauma of a breast cancer diagnosis and all the treatment decisions that it brings with it, most women need the support of a friend who can help with researching reconstruction options and what they entail.
Source: Breast reconstruction: current and future options, Breast Cancer: Targets and Therapy, Dovepress