Breast Reconstruction

Breast Reconstruction

The American Cancer Society estimates that 270,000 women will be diagnosed with breast cancer this year. Although many will be able to have breast conserving surgery, i.e., lumpectomy, many will need or prefer a mastectomy, or complete removal of the breast.

Some women need this procedure, because the cancer cannot be completely removed with lumpectomy alone. Others prefer it, fearing a recurrence or hoping to avoid the weeks of radiation often required after a lumpectomy.

Additionally, hundreds of other women at very high risk of breast cancer will undergo prophylactic mastectomy, or removal of their breasts to prevent breast cancer.

To many women, the loss of a breast is a devastating occurrence, one that strikes at their very sense of self. They may feel less feminine without a breast, find it awkward to have a missing breast or breasts under clothes, and find using a prosthesis, or rubber breast form, difficult. Thus, many women choose to undergo breast reconstruction after mastectomy.

In 2004, about 62,000 women underwent some form of breast reconstruction, according to the American Society of Plastic Surgeons. That figure represents a 22 percent decrease since 2000, likely due to the greater number of breast conserving surgeries being performed today.

Overall, however, studies find that breast reconstruction surgery is underutilized. A recent report published in the Journal of the American Medical Association showed that of the 51,000 women identified who underwent a mastectomy between 1998 and 2002; only 16.5 percent had a reconstruction.

This study also found that the decision to have reconstruction is significantly affected by where you live, your race, age and stage of cancer. Specifically, the researchers found, African-American, Hispanic and Asian women were significantly less likely to have immediate or slightly delayed reconstruction than white women.

If you choose to have breast reconstruction, you have two main options: breast implants, using silicone spheres filled with silicone gel or saline, or autologous reconstruction, which uses fat and tissue from your abdomen, back, buttocks or hips to shape a new breast. In many instances, reconstruction can be performed immediately after surgery, so you never wake up without a breast.

If you have health insurance, your carrier must pay for the procedure. The 1998 Federal Breast Reconstruction Law requires all health insurance companies to cover reconstruction of the breast on which mastectomy has been performed, and surgery and reconstruction of the other breast to produce a symmetrical appearance.

If you don't have health insurance, talk to your surgeon and the hospital about negotiating a discount rate. Many are willing to do that for women without insurance. You may also qualify for health insurance under your state's Medicaid program or other health-coverage programs for low- and moderate-income individuals.