Sexuality and breast reconstruction
Pregnancy after a breast reconstruction
The removal of a breast due to breast cancer may affect how you feel about yourself and your relationships. Some women may feel they are less sexually attractive to their partner. Having a breast reconstruction, for some women, can be a way of helping to retain their sense of being a woman after a mastectomy. Share your feelings with your partner. If you do not have a partner, or are worried about forming new relationships, it can help to talk about how you feel with a breast care nurse. Call the Cancer Council Helpline on 13 11 20 for information and support.
Breast reconstruction should not interfere with a woman's normal sexual activity, however sensitivity in the reconstructed breast will not be the same as it is in the remaining breast. It may be some time until you feel you are ready for sex. It will help if your partner can provide reassurance. You may need to build up your confidence gradually. Talking about your needs together is important to help you feel more confident and to reduce any fears.
If you find that you are having difficulty resuming your sexual relationship, you may need specialist help and advice. You may want to talk with your general practitioner about this or ask for advice on where you can get help. Remember, it is normal not to feel like sex at all after being treated for cancer.
Whether or not to become pregnant after breast cancer, and if so when, is an issue for many women. Discuss this with your oncologist.
Pregnancy after a breast reconstruction is possible, regardless of the type of reconstruction. An implant reconstruction does not affect the abdominal wall muscles, therefore pregnancy can proceed as usual. Pregnancy after a flap reconstruction is still possible, with few physical limitations, despite it being a more complicated operation. Mesh implanted into the abdominal wall during a TRAM flap operation is designed to support the abdominal wall muscles and will help to decrease the risk of a hernia in pregnancy. Always discuss the issue of pregnancy after breast reconstruction with your surgeon.
Breastfeeding is not possible with the reconstructed breast. Most women can successfully breastfeed with their other breast. A breast care nurse can advise you about any concerns you have about breastfeeding after a reconstruction.
Make sure you know how much it will cost you to have a breast reconstruction. Check with your surgeon, your hospital, Medicare and your private health fund before deciding to go ahead.
Reconstruction after a mastectomy is a medical procedure, not a cosmetic one. This means that, through Medicare, the cost may be covered completely for a public patient in a public hospital. However there may be some extra charges if an implant is used. There may also be some other charges for private patients in a public hospital. Because of the demand for public hospital beds, you may have to wait a long time for your operation. Check this with your surgeon.
If you don't want to wait so long and want to choose your own plastic surgeon, then you will need to be covered by private health insurance or be prepared to pay the extra costs yourself. If you already have private health insurance, check what you are covered for before deciding to go ahead with the surgery. Your insurance may not cover the total cost.
If you don't already belong to a private health fund but decide to join one before your operation, remember that the reconstruction is the result of a ‘pre-existing illness'. You will need to wait the full qualifying period before you can make a claim. Sometimes this is as long as a year. Check this with the various funds before deciding which one to join.
Whether or not you have insurance, check what costs are involved. In a private hospital Medicare will cover some of the surgeon's and anaesthetist's fees and you will be able to claim an extra benefit for these through your private health fund. Part or all of the cost of the inflatable tissue expander and any permanent implant may also be covered by your private health insurance.
Each hospital has its own charges and you must check these too. The rebate you get depends upon which private fund you belong to and which level of cover you have paid for. Financial assistance may be available for transport costs to medical appointments, prescription medicines, or through grants, benefits or pensions. Contact the social worker at your hospital.
Having a breast reconstruction is a matter of personal choice. It can involve a great deal of thought and discussion. Take time to get a good understanding of what a reconstruction involves and make sure that you have realistic expectations of the end result.
Use the questions on the next page to help you think through the questions you need answered. Talk to your general practitioner, surgeon and breast care nurse until you are sure you know what is going to happen and how it will happen.
If you are unsure about something and cannot be satisfied about it, feel confident enough to ask for a second opinion. Contact the Cancer Council Helpline on 13 11 20 if you need further help. If you have carefully thought about the issues involved and sought answers to all your questions, then you are in the best possible position to make your own decision.
Updated Sept 2005
