Breast cancer affects 1 in 8 women in the United States. The impact of breast cancer reaches almost everyone. Over the last few decades, advancements in breast reconstruction have provided women the ability to rebuild what the cancer has taken away. Every woman diagnosed with breast cancer deserves to have clear, accurate information about their options for breast reconstruction.
A breast reconstruction can be performed in a multitude of ways. These ways include breast implants, using your own tissue to rebuild the breast, or a combination of both tissue and implants. Even lumpectomies can be reconstructed if the amount of breast tissue to be removed is large enough.
Understanding what your options are is the first step towards a reconstruction. To schedule a consultation to discuss your breast surgery options with board-certified plastic surgeon Dr. David Bogue, please call 561-886-1000. Our office sees patients from Boca Raton, Fort Lauderdale, and the surrounding areas in Florida.
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"Dr. Bogue – Hello! It's been a while now, but I can't help finding myself being 'extra' grateful each year as Breast Cancer Awareness month gets underway. Thanks so much for being such an awesome, talented, compassionate, and kind surgeon, and for putting me 'back together' after cancer, and making me feel beautiful again!"
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Types of Reconstructive Breast Surgeries
Breast reconstruction is tailored to you. Dr. Bogue can recommend a particular surgical approach once he has met you and discussed where you are currently in your treatment and what breast surgeries you plan to undergo. Reconstructive breast techniques consist primarily of the following approaches:
Implant-based Breast Reconstruction
Many women opt for breast reconstruction using saline or silicone breast implants. An implant-based reconstruction can often be performed in a single stage at the time of the mastectomy without the need for a tissue expander.
Correction of Lumpectomy Defect
A lumpectomy often leaves a large defect in the breast. These can be corrected at the time of surgery using “oncoplastic” techniques. These techniques use your remaining breast tissue to fill in the defect and also to reshape, lift, or reduce the breast. Symmetry procedures are usually performed on the other breast at the same time. Fat transfer is a particularly helpful technique used to fill in divots or indentations left behind by lumpectomies in the past.
Autologous Tissue Breast Reconstruction
A flap of your own muscle, skin, and fat is used in this technique to restore a breast mound. It's also called flap-based reconstruction and includes TRAM flaps, latissimus flaps, and DIEP flaps.
Dr. Bogue does not perform DIEP flap or free flap breast reconstruction. If you are interested in a DIEP flap surgery, please visit www.plasticsurgery.org to find a DIEP flap surgeon near you.
Dr. Bogue demystifies all of the factors involved in breast reconstruction so that you can make informed decisions about what to do next.
When to Consider Breast Reconstruction
If you have recently been diagnosed with breast cancer: You have the right to a breast reconstruction consultation.
Your consultation should occur prior to any lumpectomy or mastectomy. During this consultation, Dr. Bogue will review your oncologic plan, your breast anatomy, your goals from reconstruction, and the options required to achieve those goals.
If you have already had a breast reconstruction but are interested in improvement: Dr. Bogue has considerable experience improving and correcting issues related to breast reconstruction. Options range from small scar revisions to complete reconstruction restarts.
If you declined reconstruction in the past, but are now reconsidering: Many women decline reconstruction in the past only to find that they would like to pursue reconstruction later.
A “delayed” reconstruction may be performed at any time in the future. During your consultation with Dr. Bogue, you will learn what the process entails and what you can expect.
Planning Your Breast Reconstruction
There is a lot to consider when you’re planning to have a breast reconstruction surgery, such as the best timeline and potential costs:
Timing of Your Breast Reconstruction
Most breast reconstructions start at the time of mastectomy or lumpectomy. This is known as an “immediate” reconstruction. Many reconstructions can be performed in one operation, while others require two or more operations or “stages.”
In certain instances, the reconstruction is “delayed” until a later date. The timing of reconstruction depends upon the stage of the tumor, the need for chemotherapy or radiation, the reconstruction type, and patient preference. All of these factors are considered during your consultation with Dr. Bogue.
Cost of Breast Reconstruction
Your right to breast reconstruction is mandated by the Women’s Health Care and Cancer Rights Act of 1998. This federal law ensures that insurance companies cover the cost of reconstruction when covering the cost of mastectomy or lumpectomy. This includes procedures for the contralateral breast to achieve symmetry (including breast augmentation, breast lift, or reduction). Dr. Bogue accepts most major insurance plans, including Medicare.
Reasons to Consider Breast Reconstruction
There is no right or wrong reason for wanting to have breast reconstruction. Many women feel incomplete when missing one or both breasts after mastectomy. The scar that you see every morning getting out of the shower can be a reminder of what breast cancer took from you. It can impact your self-esteem and body image to the point where you avoid sex or other intimate situations. If you are dealing with any of these emotional challenges, breast reconstruction is worth considering.
What to Expect on Surgery Day
On the day of your breast reconstruction surgery, the focus will be on keeping you comfortable and well-informed.
Before the Procedure
You will arrive at the hospital or surgical center, where the team will guide you through check-in and answer any last-minute questions. Dr. Bogue will meet with you briefly to review the procedure and ensure you feel prepared.
During the Surgery
Once in the operating room, you will be given general anesthesia so you are completely asleep and pain-free throughout the surgery. The specific steps of the procedure depend on the type of reconstruction you are having, but Dr. Bogue and his team will work carefully to achieve the best possible outcome.
After Surgery
You will wake up in a recovery area, where the team will monitor you closely as you begin to wake up and feel more alert. You can expect to feel a little tired and sore, but the staff will ensure you are comfortable.
Patients undergoing more extensive surgeries, like flap-based reconstruction, may need to stay in the hospital for additional monitoring and care. For simpler procedures, such as implant placement, patients often return home the same day once they are stable.
Recovering From Breast Reconstruction
This is not an easy recovery, but after fighting breast cancer, many women are up to the task. Your recovery period and difficulty can vary widely due to the variety of possible surgical methods. Here’s what recovery generally entails:
- Hospital stays can run from one to six nights.
- Expect to be tired and sore for up to two weeks, with full recovery taking up to six weeks. Remember, you’re basically recovering from two procedures.
- When you return home, Dr. Bogue will have placed bandages and elastic supports to allow the newly reconstructed breast to heal properly without undue stress.
- There will likely be a drainage tube.
- A pain pump will help reduce the need for narcotic pain relievers.
We’ll give you detailed instructions on what you can and cannot do to impact your incisions and such. As a rule, you’ll need to refrain from any overhead lifting, strenuous exercise, and any sexual activity for up to six weeks following your surgery.
Why Choose Dr. David Bogue for Your Breast Reconstruction
Dr. David Bogue is a board-certified plastic surgeon with years of specialized training, including a six-year residency at Georgetown University Hospital. He served as Chief of the Department of Surgery at Boca Raton Regional Hospital and has contributed to multiple respected publications in plastic surgery. With his background in reconstructive procedures, Dr. Bogue works with each patient to determine the best approach.
Patients appreciate Dr. Bogue’s clear communication and steady approach. He takes the time to explain options, answer questions, and guide you through the process. Known in the Boca Raton and Fort Lauderdale communities for his professionalism, Dr. Bogue has helped many women feel more confident with breast reconstruction surgery.
Breast Reconstruction FAQs:
Why Is a Tissue Expander Used Before an Implant?
Following a mastectomy, the skin of the breast is usually not removed. However, this skin is very fragile. A tissue expander allows for the creation of a pocket space for the future implant while allowing for gradual expansion of the space without hurting the overlying skin. There are times when the placement of an implant in one stage is possible.
What Is Acellular Dermal Matrix?
Acellular dermal matrix (ADM) is donated human skin treated in a process that removes all of the cells, leaving a sheet of collagen. This sheet of collagen is used to cover the lower portion of a tissue expander, sets the reconstruction precisely along the breast fold, and reduces long-term complications such as capsular contracture.
What Is the SPY System?
The SPY system is a blood flow camera used during the surgery to evaluate the blood flow in the skin following mastectomy. The use of the SPY system allows us to predict who will have issues healing and who may benefit from hyperbaric oxygen therapy after surgery.
Is Surgery on the Non-Cancer Breast Covered By Insurance?
In 1998, the US Congress passed the Women's Health and Cancer Rights Act mandating coverage by insurance companies for the procedures on the contralateral (non-cancer) breast to achieve symmetry in breast reconstruction. This includes breast augmentations, breast lifts, and breast reductions.
Patient Testimonials:
"Dr. Bogue is simply one of the best doctors and plastic surgeons there is. As an eleven year survivor of stage 3 breast cancer I had given up hope of making my radiated breast healthy or normal in any way. Dr. Bogue proposed using skin from my back to help redo the skin that was damaged from chemo and radiation. The surgery was not easy but it went smoothly. Dr. Bogue helped me to have a great, amazing outcome on both the cancer and non-cancer sides. It turned out much better than my expectations. Dr. Bogue is kind, hard working, and highly thought of by hospital staff, which is a great testament to him. His nursing and office staff are true professionals and very kind. Every cancer survivor who has had reconstruction with him is so happy with their outcome. Thank you Dr. Bogue!!!"
"Dr. Bogue came highly recommended to me when I needed breast reconstruction after a mastectomy. A true professional, I felt I couldn't be in better hands. His extensive experience gave me confidence when facing the risk of surgery and resulted in an excellent medical and aesthetic outcome. Thank you, Dr. Bogue!"
"Great professionalism and excellent surgical skills. As a surgical PA-C myself, ironically I was intimidated by the thought of undergoing an elective surgery. Dr. B and his staff were thorough, kind and supportive throughout the whole process. Thank you for helping me on my journey to be my best self!"
How Should I Prepare for Breast Reconstruction?
Whether Dr. Bogue is performing reconstruction immediately following your mastectomy or later, you’ll want to prepare for your recovery by doing the following:
- You’ll stop taking blood thinning medication, aspirin, anti-inflammatory medications, and most herbal supplements for one week prior to your surgery.
- If you smoke, you’ll need to stop for at least two weeks before and after your surgery, as smoking constricts the blood vessels, and this impedes healing.
- You’ll want to prepare your recovery nest, as you’ll need to lay low for at least a couple of weeks.
- Prepare your recovery nest ahead of time so you’ll be as comfortable as possible. Lots of pillows, blankets, and every sort of entertainment and amenity you may need.
- Part of your preparation needs to be enlisting help during recovery. You’ll be extremely tired for at least a full week and likely longer, so ask a loved one who can help assist you as needed, even with things like household chores or childcare.
Will There Be Scarring After Breast Reconstruction?
There will be scarring with either type of reconstruction. With flap procedures performed by other surgeons, there will be scarring at the donor site and on the reconstructed breast. These scars will begin as angry red in color, but they will fade substantially over time.
If Dr. Bogue is performing your reconstruction with breast implants, he works hard to limit scarring. He will typically make the incisions along the breast crease where they are well hidden. The type of mastectomy dictates whether you can keep your nipples or whether Dr. Bogue will reconstruct the nipple-areola complex.
Some breast cancer patients had prior augmentation, and Dr. Bogue can often use the same breast pockets.
As you can see, there is a good deal of variation in these procedures, but Dr. Bogue has a reputation for giving our patients the least visible scarring moving forward.
How Long Will the Results of My Breast Reconstruction Surgery Last?
Flap procedures are permanent. If all goes well, there won’t be any need for any further surgery going forward.
If Dr. Bogue performed breast reconstruction with implants, breast implants have a lifespan. All breast implant manufacturers currently guarantee their implants for at least 10 years, and they will pay for all costs of replacement surgery should it be necessary prior to that time frame. Breast implants can last far longer than 10 years. Implant durability is improving.
If you are younger, you’ll expect to need implant replacement surgery at least twice over the remainder of your life. If you’re middle-aged, you may only need a single replacement. These replacement procedures are not difficult, as Dr. Bogue can usually use the same incisions to remove the old implants and place the new ones.
What Are the Risks Associated With Breast Reconstruction?
Like any major surgery, breast reconstruction carries some potential risks, though they are manageable and often rare. These may include temporary challenges such as delayed healing, minor infections, fluid buildup, or reactions to anesthesia.
In some cases, additional follow-up procedures may be needed to address concerns during the recovery process. Specific considerations can include:
- Minor complications at the donor site in flap-based reconstruction, such as changes in muscle strength
- Subtle differences in breast symmetry, which can often be corrected
- Changes in sensation in the arm or breast area
- For implant-based reconstruction, rare issues like implant leakage, rupture, or capsular contracture (scar tissue forming around the implant)
Dr. Bogue and his team take every precaution to minimize these risks and ensure a smooth recovery. By following detailed post-surgery instructions and attending follow-up visits, most patients heal well and enjoy long-term results.
Will My Reconstructed Breast Feel Natural to the Touch?
Your reconstructed breast will look and feel different from your natural breast, but Dr. Bogue uses techniques to create as natural a result as possible. If implants are used, they may feel firmer than natural breast tissue. Flap-based reconstruction, which uses your own tissue, can provide a softer, more natural feel. While sensation is often reduced or lost in the reconstructed breast, some women regain partial sensation over time.
How Long Will It Take for My Scars to Fade After Breast Reconstruction?
Initially, scars may appear red or raised, but within several months to a year, they will begin to fade and flatten. Dr. Bogue uses techniques to limit scarring, often placing incisions in areas where they are less noticeable, like along the breast crease. Your healing process will depend on your body, the type of reconstruction, and how well you care for your incisions during recovery.
Schedule Your Consultation Today!
If you are considering breast reconstruction and want to learn about your surgical options, please contact the practice of board-certified plastic surgeon Dr. David Bogue at 561-886-1000. Dr. Bogue's office is located in Boca Raton, and he serves people from across the state, including West Palm Beach and Fort Lauderdale.
