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.
Questions About Breast Reconstruction
Q: 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.
Q: 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.
Q: 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.
Q: 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.
Q: 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.
If you are considering breast reconstruction and want to learn about your surgical options, please call 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.