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 options with board-certified plastic surgeon Dr. David Bogue, please call (561) 886-1002.
"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!" – Amy
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.
- 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*.
- 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.
* 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.
Planning for Breast Reconstruction
If you have recently been diagnosed with breast cancer: A breast reconstruction consultation is your right as a breast cancer patient. Your breast reconstruction 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 already have 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.
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, reconstruction type, and patient preference. All of these factors are considered during your consultation with Dr. Bogue.
Cost of breast reconstruction: A patient’s right to a 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 participates with most major insurance plans including Medicare.
Breast Reconstruction FAQs:
What types of breast reconstruction are there?
A: Reconstruction of the breast can be performed with tissue expanders and implants, autologous (your own tissue) reconstruction, or a combination of the two. There are indications for each type and patient preference is an important factor.
Why is a tissue expander used before an implant?
A: 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?
A: 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?
A: 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?
A: 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.
- "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!!!" - M.F.
- "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!" - E.C.
- "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!" - E.M.
What are the benefits of breast reconstruction?
A: 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 faces them every morning getting out of the shower is a reminder of what breast cancer took from them. It can impact the self-esteem and body image to the point where the woman avoids sex or other intimate situations. She may stop going to the beach or stop even wearing a swimsuit.
What are the benefits of breast reconstruction?
A: The benefits of breast reconstruction with Dr. Bogue are personal, but here are some of the pluses our patients detail.
· The woman seeks balance when wearing a bra or swimsuit.
· She doesn’t feel whole missing a breast.
· She doesn’t have any interest in using breast forms worn inside a bra.
· She wants to feel good about her body and herself.
What will my recovery entail?
A: This is not an easy recovery, but after what you’ve already been through fighting breast cancer you’ll be up to the task. Your recovery period and difficulty can vary widely due to the variety of methods that can be employed. Hospital stays can run from one to six nights. Patients are generally tired and sore for up to two weeks, with full recovery taking up to six weeks. You need to remember that 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 is effective to 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.
How should I prepare for breast reconstruction?
A: Whether Dr. Bogue is performing reconstruction immediately following your mastectomy or later, you’ll want to make most of your preparation for your recovery. Of course, you’ll need to prepare as you would with any surgery — 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 weeks. You’ll be tired after the combination surgery of mastectomy with your breast surgeon and reconstruction with Dr. Bogue. Getting back to normal activities may take six weeks or longer. Really taking it easy helps your recovery, so your recovery nest needs to be a place where you’re utterly comfortable. Lots of pillows, blankets, and every sort of entertainment.
Part of your preparation needs to be enlisting help. You’ll be completely wiped for at least a full week and likely longer. You won’t be able to do any overhead lifting or any heavy lifting for a few weeks. Strenuous physical activity or exercise will probably be put off for six weeks. This is no time to be the Lone Ranger and push your recovery timelines.
Will there be scarring after breast reconstruction?
A: 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 sense, 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?
A: 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 with breast reconstruction?
A: Breast reconstruction is certainly major surgery. Because of that, it involves all the risks that accompany major surgery: poor wound healing, infection, excessive bleeding, reaction to anesthesia, fluid accumulation, and the formation of blood clots.
But there are a variety of problems that can occur later in the recovery process:
· The need for follow-up procedures to address problems
· Tissue death in flap procedures
· Problems at the donor site where tissue was taken, such as loss of muscle strength
· Asymmetry between your breasts
· Changes in the arm on the side of the reconstructed breast
· Problems with the breast implant, such as leakage, rupture, or capsular contracture
· Asymmetry between your breasts
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) 886-1002. Dr. Bogue's office is located in Boca Raton and he serves people from across the state, including West Palm Beach and Fort Lauderdale.