Deciding About Breast Reconstruction

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For those who have undergone a mastectomy or experienced significant breast trauma, choosing to pursue breast reconstruction can be a deeply personal and meaningful decision. Whether or not to proceed with reconstruction is unique to each patient and depends on several factors, including medical considerations, emotional readiness, and personal preferences. If you are considering breast reconstruction, here are a few important points to keep in mind:

1. Risks of breast reconstruction

As with any surgery, breast reconstruction carries certain inherent risks and potential side effects, both in the short and long term. Early complications may include anesthesia-related issues, bleeding, infection, fluid accumulation, wound healing problems, and fatigue. Long-term concerns can involve tissue necrosis, changes in breast or nipple sensation, donor site complications, and implant-related issues such as leakage, rupture, or capsular contracture. Infection, particularly within the first two weeks, may sometimes necessitate implant removal. While issues like asymmetry or sensory changes may arise, most can be effectively managed through follow-up care or additional procedures.

2. Reasons to have breast reconstruction

A woman may choose to undergo breast reconstruction for several reasons, including achieving a more balanced fit in a bra or swimsuit, improving how clothes fit, restoring the breast’s shape permanently, eliminating the need for an external prosthesis, and boosting self-confidence about her body. While reconstruction typically results in some scarring, modern techniques have reduced its severity, and most scars fade over time. The reconstructed breast will not be identical to the natural one, and if tissue is taken from another part of the body, that area may also have a changed appearance. It is important to talk with your surgeon about possible scarring and changes in shape before making a decision.

3. Does insurance cover breast reconstruction?

Most health plans are required to cover your surgery, whether it takes place a week, a month, or even years after a mastectomy, due to the Women’s Health and Cancer Rights Act of 1998. This law mandates that most insurance plans covering mastectomies must also cover breast reconstruction, including surgery on the opposite breast if needed to achieve symmetry. The Affordable Care Act provides additional protections, and Medicare includes breast reconstruction coverage. If you’re covered by Medicaid, it's important to check your state’s specific rules, as Medicaid coverage can vary.

4. Is there still sensation in the reconstructed breast?

Most women feel considerable disappointment with the loss of sensation following breast surgery, though the extent varies depending on the type of procedure. A nipple-sparing mastectomy, which preserves the skin, nipple, and areola, may retain more feeling than a full reconstruction. While some sensation is always lost, the natural nipple generally maintains more sensitivity than a reconstructed one. Current research is focused on restoring feeling through nerve grafting, but nerves regrow slowly—about a millimeter per day—and success depends on preserving key nerves in their proper anatomical position. Still, with today’s advanced techniques that restore the breast’s appearance and feel, many women experience a renewed sense of wholeness.

5. Who is not a candidate for reconstructive surgery?

Certain women may not be in good enough health to recover well from breast reconstruction surgery, and smokers are at a higher risk of complications with DIEP flap procedures. Nicotine causes blood vessels to narrow, making them more prone to spasms, which can result in flap loss. It also significantly slows the healing process. In some cases, previous abdominal surgeries may rule out the DIEP flap option due to scarring, but this isn’t always the case—a CT scan can help determine if there are still viable blood vessels. However, if someone has had a tummy tuck, DIEP flap surgery is no longer possible, as the tissue needed for reconstruction has already been removed.