POST-CANCER BREAST RECONSTRUCTION: A very personal choice

By Andrea Busche

In a battle with breast cancer, a woman’s ultimate priority is health and wellness. Some women opt solely for life-saving treatments, eschewing any aesthetic surgical procedures.

But when a mastectomy or bilateral mastectomy is required, many women opt to have their breast or breasts reconstructed. For these women, modern medicine presents a few options.

Early consultation

Dr. Jay Fowler is a plastic and reconstructive surgeon with Northland Plastic Surgery in Duluth and explained when a woman receives a diagnosis of breast cancer requiring mastectomy, a plastic surgeon is often consulted early in the process.

“We are brought in very early to talk about the woman’s reconstructive options,” he said. He also shared that some women are getting mastectomies preventatively, as a risk-reduction measure, adding, “This is becoming more popular due to genetic testing.”

Fowler is board-certified by the American Board of Plastic Surgery (ABPS). He recommends that all patients seeking breast reconstruction surgery select a plastic surgeon who retains this important certification.

Two options

Fowler said there are two options for breast reconstruction: autologous tissue transfer, also known as a flap, or implant reconstruction. For the flap procedure, the surgeon uses the woman’s own skin and subcutaneous tissue to rebuild her breasts. A second possible technique uses a muscle from the back (latissimus dorsi) to refashion the breast. This sometimes also requires the use of a prosthesis, either a tissue expander or permanent implant.

“Results of this procedure are phenomenal,” Fowler said of the autologous tissue transfer surgery, “but there is a lot of upfront effort for the patient. It is a longer process, a more difficult surgery, and can have more complications.”

With implant reconstruction, a tissue expander is usually placed through the mastectomy incision. After healing, the expander is gradually filled until a permanent implant (either saline or silicone) can be placed.

Each technique has advantages and disadvantages that depend upon each individual situation. Either technique can be performed at the time of the mastectomy (unless radiation is required, in which case it will likely need to wait), or at any time thereafter. Depending on their type of cancer, some women can receive what’s known as a nipplesparing mastectomy. But, if that isn’t possible, surgeons can also reconstruct a nipple using special surgical techniques and adding pigment via a tattooing process at a later date.

Covered by insurance

Rachael Perlinger is clinic administrator for Northland Plastic Surgery. She explained that breast reconstruction is covered by most major

insurance providers.

“There is a federal law –,” she said, “The Women’s Health and Cancer Rights Act of 1998. This law states that if an insurance company covers a mastectomy, they must also cover reconstruction.”

Individual choice

While many women choose to have breast reconstruction after a mastectomy, some women make other choices.

“Some women get reconstruction, some women go completely natural, some wear prosthetics, and some get tattoos over their mastectomy area,” Perlinger said. “A woman’s cancer journey is so personal.”

Fowler agreed.

“Some women, primarily those who are older, don’t want reconstruction. That’s an individual choice. The most important thing is that you’re cancer-free.”

Return to wholeness

For many women, their cancer journey is a multi-year process. Their course of treatment often involves chemo, radiation, and multiple frightening and painful surgeries. Breast reconstruction is typically the last step, and can help restore a woman’s self-confidence and sense of femininity.

“We have the privilege of walk with these women through the end of their journey,” Perlinger said. “Reconstruction is a part of making her feel whole. And it is our honor to make her feel like herself again.”