Breast reconstruction

Thursday 1 June, 2017

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On this page: When can I have a reconstruction? | Types of reconstruction | Implant reconstruction | Flap reconstruction | Nipple adhesives and reconstruction | Surgery to the other breast | What to expect after the operation | Costs and financial assistance | Who will do the reconstruction? | Which health professionals will I see? | Question checklist | Key points


This section provides information about breast reconstruction for women who have had breast surgery.

When can I have a reconstruction?

Breast reconstruction can be done at the time of the mastectomy (immediate reconstruction) or months or years later (delayed reconstruction). The timing depends on the type of breast cancer you were diagnosed with, whether you need further treatment (for example, chemotherapy or radiotherapy), your general health, and other concerns, such as the cost.

Some women plan the reconstruction from the time of their mastectomy, others prefer to focus on treatment and think about reconstruction later. Sometimes you won't be able to have an immediate reconstruction due to the surgery schedule at the hospital. Discuss these issues with your breast cancer surgeon, oncoplastic surgeon and/or reconstructive (plastic) surgeon.

Types of breast reconstruction

The main types of breast reconstruction are implant reconstruction or flap reconstruction, or a combination of the two. If having an immediate reconstruction, it can be combined with total, skinsparing or nipple-sparing mastectomy (see below).

Most reconstructions involve two or more operations several weeks or months apart. Your reconstructive surgeon will discuss the different methods and suggest the most suitable one for you.

Your reconstruction options will depend on several factors:

  • your body shape and build
  • your general health
  • the surgeon's experience
  • the amount of tissue that has already been removed
  • any scars from other operations
  • the quality of the remaining skin and muscle
  • the breast size you would like
  • whether one or both breasts are affected
  • whether you need radiotherapy or have already had it
  • whether you smoke – this affects the type of flap you can have, as some types of operations are more likely to have complications in smokers or women who have recently quit.

Skin- and nipple-sparing mastectomy and breast reconstruction

You may be able to have a mastectomy that preserves the skin or nipple (called skin-sparing mastectomy or nipple-sparing mastectomy).

In these operations the breast tissue is removed, but most or all of the skin (and sometimes the nipple) is preserved. This often makes the reconstruction appear more natural and any scars are usually less visible. Some type of immediate reconstruction is also performed at the same time as the mastectomy to fill out the skin.

These operations are not suitable for all types of breast cancer, so you should discuss this option with your breast cancer surgeon.

Implant reconstruction

An implant is a sac that's filled with either silicone gel or a saltwater solution (saline). It is surgically inserted into the body to create a new breast shape.

There are benefits and drawbacks to having an implant – see the table below for more details. You need to discuss these with your surgeon. You may also find it helpful to talk with someone who has an implant – Cancer Council 13 11 20 or a breast care nurse may be able to put you in touch with someone.

Types of implants

Silicone implants

These are used in almost all operations. A softer, honey-like type of gel was previously used, but implants are now made of a soft, semi-solid filling called cohesive gel. This gel is quite firm and holds its shape like jelly.

Some silicone implants are covered with a thin layer of polyurethane foam, which helps hold the implant in place. This can reduce the risk of the implant hardening or moving.

Saline implants

These are made of a solid silicone envelope filled with sterile saltwater (saline). They are no longer commonly used in reconstruction. Saline breast implants don't look and feel as natural as silicone implants. A saline implant may gradually lose volume, deflate without warning or wear out. Skin wrinkling and "sloshing" may also occur.

See information on the safety of implants.

What to consider – implant reconstruction

Benefits

Drawbacks

  • Operation takes only a few hours and you usually only stay in hospital for a few days.
  • Creates the breast shape without moving tissue (muscle, skin or fat) from elsewhere in the body, so other parts of the body aren't affected.
  • Only one scar from the mastectomy.
  • Recovery time at home is shorter than for a flap reconstruction. Although the chest area will be swollen and sensitive, you may be able to return to most activities within about a week.
  • Implants come in a range of shapes and sizes. You can choose to change your original breast size.
  • Doesn't change in size if your weight changes.
  • Doesn't cause issues, such as muscle weakness, that may occur as a result of a flap reconstruction.
  •  Two or more operations may be required, if you have an expander first or if the expander is used as the implant. You will need regular doctor's visits to gradually fill the expander. The whole process may take 3–6 months.
  • A breast reconstructed with a tissue expander and/or an implant usually feels firmer than a natural breast. While it won't move like a natural breast, it usually looks the same (symmetrical) in a bra.
  • If your other breast changes in shape and size, you may need further surgery to match the two.
  • Hardened scar tissue (capsule) may form around the implant. This can distort the shape of the breast and cause pain in some circumstances.
  • Risk of infection, which may mean removing the implant.
  • Implants may need to be replaced after 10–15 years, but some can last for longer.

Woman with an implant reconstruction

After the reconstruction you will have a scar on your breast.

Woman with an implant reconstruction

How an implant reconstruction is done

An implant reconstruction can be done in one operation or as a two-stage operation (this process is shown below).

One-stage operation

This is used when there is enough skin to insert the implant under the chest muscle to replace the removed breast tissue. The operation is usually done at the same time as a skin- or nipple-sparing mastectomy. A dermal matrix or mesh is often used to cover part of the implant (see below) and this helps keep the implant in place.

Two-stage operation

In the first operation a balloon-like bag called an inflatable tissue expander is placed under the skin and chest muscle. The balloon is injected every couple of weeks with saline through a port that sits just under the skin. You may have 1–6 injections depending on how much the skin needs to stretch. The stretched tissue creates a pocket for the implant. After about six weeks, the temporary expander is removed and replaced with a permanent silicone or saline implant in a second operation. This procedure may require an overnight hospital stay.

Stages of delayed breast reconstruction with a tissue expander

Before the tissue expander process

The chest tissue is mostly flat, because breast tissue was removed during the mastectomy.

Stages of delayed breast reconstruction with a tissue expander

Implanting the tissue expander

Inserting the tissue expander creates a pocket for the implant. There is a port through which the saline can be injected. The saline injections cause little pain because the chest has no feeling after a mastectomy.

Stages of delayed breast reconstruction with a tissue expander

Expanding the tissue expander

The tissue stretches and expands each time saline is added. You may feel discomfort for a few days. After several weeks the expander is removed and the implant is inserted in its place.

Stages of delayed breast reconstruction with a tissue expander

Maina's story

"I had to decide how I wanted to recreate my breasts before my bilateral mastectomy. I knew I didn't want to have further surgery as I felt I had been through enough.

"I decided on an implant reconstruction using the expander process. This was done at the time of the mastectomy. Every three weeks I had injections with saline to expand the skin. The injections didn't hurt because there were no nerves anymore.

"I had to have chemotherapy after the bilateral mastectomy so I had to wait five months after chemotherapy before finishing the reconstruction. And then I had to have more surgery to put the silicone implant in.

"I was very upset after the reconstruction. I had discussed size with the surgeon and asked to see samples, but I wasn't able to see them. Before the mastectomy I was a D cup, but after the reconstruction I was an A cup.

"The surgeon redid the reconstruction and I still wasn't happy but that's the way it is now. After the surgery I had a nipple tattoo.

"I haven't had any side effects after the reconstruction. At one stage it looked a little flatter in one breast and I was sent to check the implants weren't leaking. I really don't need to wear a bra anymore, just crop tops sometimes. I also tend to wear scarves around my shoulders. It looks like I have breasts, but I don't. I am very comfortable with the decision. My breasts feel comfortable.

"You must tell the surgeon what type of breasts you want. You can write your own story now. You can be in charge because you'll have these breasts forever."

Tell your cancer story.

Acellular dermal matrix

If there is not enough tissue to cover the entire implant other material called acellular dermal matrix (ADM) is used. This may be from animal (cow or pig) or human tissue. Sometimes synthetic material is used. The ADM is processed and sterilised for use in surgery. It is cut to size and modelled to the shape of the breast. When in place, ADM works like building scaffolding – it is there to support and contain the breast implant. Your existing skin will grow into the ADM or the synthetic mesh as the area heals.

Risks of having an implant reconstruction

Before the operation, the surgeon will discuss the risks of an implant reconstruction with you. These may include:

Infection

You'll be given antibiotics at the time of the operation to reduce the risk of infection. But if this happens, the implant usually has to be removed until the infection clears. The implant can then be replaced with a new one.

Implant rupture

Implants don't last a lifetime. They can leak or break (rupture) because of gradual weakening of the silicone over time. According to the US Food and Drug Administration, about one in 10 of all silicone implants break or leak within 10 years of being implanted. The average implant lasts about 15 years. Usually, if an implant is known to have ruptured, it is replaced.

If a saline implant ruptures, salty water will leak into your body. The salty water is not harmful, but you will need to have surgery to remove the empty silicone envelope and replace the implant.

Hardening of the implant

A fibrous covering forms around a breast implant. If this hardens over time, it may make the reconstructed breast feel firm. This is called capsular contracture, and it is more common after radiotherapy. Capsular contracture can be uncomfortable or painful and may change the shape of the breast. Further surgery may be needed to remove and/or replace the implant.

Movement

The position of the implant in the body may change slightly over time. This is called implant displacement, descent or rotation. In a small number of cases, the implant shifts a lot and changes the shape of the breast. Further surgery can restore the implant to its original position.

Visible rippling

Sometimes implants adhere to the surface of the skin and this can affect how smooth the breast is.

Other health problems

There have been reports of a link between a rare type of lymphoma and breast implants. Since 2007, 53 cases of anaplastic large cell lymphoma (ALCL) have been diagnosed in Australia. The Therapeutic Goods Administration (TGA) recommends women monitor their breasts for any changes and have their implants checked regularly. If you are concerned, talk to your surgeon.

Research has not established a link between silicone breast implants and autoimmune disorders such as scleroderma, rheumatoid arthritis or lupus. There is also no evidence that implants cause breast cancer.

Staying informed about the safety of your implants

While implants are generally considered to be safe, there have been some concerns about risks.

Some silicone implants were voluntarily taken off the market in the 1990s due to safety concerns. Since then, regulatory authorities such as the Therapeutic Goods Administration (TGA) must approve brands used in Australia.

In April 2010, the French breast implant brand Poly Implant ProthËse (PIP) was withdrawn due to safety concerns and a possible increased likelihood of ruptures.

About 5000 Australians had a PIP implant between 2000 and 2010, but most of these were cosmetic procedures. Women worried about the safety of their implant should discuss any concerns with their surgeon.

The Australian Breast Device Registry (ABDR) is a national clinical quality registry for all people having breast implant surgery. The aim of the registry is to provide a way to track how the products perform and what the patient outcomes are after surgery. This can help identify early signs of problems with a device.

ABDR is supported by the Australian Society of Plastic Surgeons, Breast Surgeons of Australia & New Zealand and Australasian College of Cosmetic Surgery. Your surgeon will provide you with printed information about the registry and you'll be contacted by ABDR after the surgery with more detailed information.

For more details on ABDR see abdr.org.au or ask your surgeon. You can also check tga.gov.au for safety alerts.

Flap reconstruction

The shape of a breast can be built using muscle, fat and skin from another part of the body. This is called a flap reconstruction. See different types of flap reconstructions.

A flap reconstruction may suit women who have large breasts, women who don't have enough skin to cover an implant, or women who have had radiotherapy. This type of reconstruction may not be suitable for women with diabetes, connective tissue disease or vascular disease, or women who have had previous major abdominal surgery or who smoke.

Lesley's story

"I delayed having a reconstruction for four years because I wanted to see if the cancer came back. I didn't really want to have to go through such an enormous operation for nothing.

"Because I'd had extensive radiotherapy to the chest area, I was only suitable for a flap reconstruction. I had a nipple reconstruction quite a long time after the TRAM flap. Twelve months after the nipple reconstruction, I had it tattooed.

"My reconstructed breast is absolutely amazing. It's very symmetrical and even. The scars are unsightly, especially on the donor site. The scar on the new breast mound is not nice. My skin was compromised badly by the radiotherapy so there was never going to be a good outcome.

"While I've had many side effects and numerous operations on the donor site, the reconstruction itself was a success."

Tell your cancer story

What to consider – flap reconstruction

Benefits

Drawbacks

  • Reconstruction is permanent once the breast has healed, even though additional treatment or follow-up surgeries are sometimes needed.
  • Most methods only use your own living tissue to create the breast. This often results in a more natural look and feel.
  • The flap maintains its look and feel over the long term and generally adjusts if your body weight changes.
  • Using your own tissue means there is no risk of possible rupture.
  • Less chance of long-term complications needing additional surgeries later in life.
  • The operation will take several hours and you may need to stay in hospital for about a week. Recovery takes longer than after an implant reconstruction as there is an abdominal or back wound as well as a breast wound to heal.
  • Risks include infection and the flap not healing properly.
  • Surgery usually causes more than one scar (but these fade over time).
  • Depending on the type of flap you have, you may need an implant as well.
  • Muscle weakness may occur after the operation, which could affect your lifestyle (e.g. problems with playing tennis or heavy lifting).
  • TRAM and DIEP procedures can only be done once.
  • With TRAM reconstruction, there is a risk of hernia.

Flap from the lower abdomen

The tissue from the lower abdomen is moved to the chest area to reconstruct the breast.

TRAM flap

The rectus abdominis muscle is a muscle in the lower abdomen that runs from the breastbone to the pubic bone. All or some of this muscle and a flap of local skin and fat is moved to the chest to form a reconstructed breast. This is called a transverse rectus abdominis myocutaneous (TRAM) flap. It can be moved in one of two ways.

Because the reconstructed breast is formed from tissue from the belly, this reconstruction means the tummy is tighter and flatter ("tummy tuck"). There will be a long scar across the lower abdomen from one hip to the other and a scar on the reconstructed breast, but little to no feeling in the skin over the breast.

Woman with a TRAM flap reconstruction

After the reconstruction you will have a scar on your breast and a scar across your abdomen.

Woman with a TRAM flap reconstruction

Types of abdominal flap reconstructions

Surgery for a flap reconstruction can be done in several ways.

Pedicle TRAM flap

The muscle remains attached to the original blood supply and is tunnelled under the skin of the upper abdomen to the breast. A pedicle TRAM flap operation usually takes 3–4 hours, and requires 4–7 days in hospital. The surgeon may also arrange to bank your blood in case you need a transfusion during surgery. About two weeks before the main operation, you may need a small operation to improve the blood supply to the tissue that will be used in the breast reconstruction. This is more common for women with larger breasts.

Free TRAM flap

The muscle is cut off from its blood supply and reattached to a blood supply in the chest or armpit. This is done using microsurgery. Free TRAM flap is better for creating a larger breast. It is also easier for the surgeon to shape the breast for a more accurate final result, but it is a more complicated and longer operation. A free TRAM flap operation takes 5–7 hours, and requires 4–7 days in hospital.

DIEP flap

A DIEP flap is similar to a TRAM flap but it uses the skin and fat to reconstruct the breast. The abdominal muscle is left in place.

This type of reconstruction is called DIEP because deep blood vessels called inferior epigastric perforator are used. The DIEP are detached and transplanted at the breast surgery site, where they're reconnected to local blood vessels in the breast area.

Whether it's possible to perform a DIEP flap or not, depends on the size of the blood vessels in your abdominal wall. Women who are in good overall health and have no existing scars on their abdomen and enough fatty tissue in the lower abdominal area, are suitable.

Location of flap reconstructions

The tissue for reconstructing your breast can come from different places. Your doctor will discuss the best location with you.

TRAM flap

Takes skin, fat and muscle from the lower abdomen. 

DIEP flap

Takes skin and fat, but no muscle, from the lower abdomen. 

LD flap

Takes skin, fat and muscle from the back.

Less common flap reconstructions

SGAP or IGAP flap

Takes fat and skin from the upper or lower bottom

TMG or TUG flap

Takes skin, fat and a small amount of muscle from the upper inner thigh.

Flap from the back (LD flap reconstruction)

The latissimus dorsi (LD) is a muscle on the back under the shoulder blade. This muscle and some skin and fat is moved from the back around to the chest to make a reconstructed breast.

This reconstruction can be completed in one operation but usually an implant is placed under the flap to create a breast that is similar in size to the remaining breast. If a tissue expander is used, the expansion process begins once the flap has healed. Unless a nipple-sparing mastectomy is performed, the areola and nipple are created in a separate operation.

The scar on the back is usually straight and can be covered by your bra strap. The scar on the breast will vary depending on the mastectomy technique used.

Location of flap reconstructions

Woman with an LD flap reconstruction

After the reconstruction you will have a scar on your breast.

Woman with an LD flap reconstruction

Some surgeons use a scarless LD flap reconstruction technique that avoids a scar on the back. The mastectomy scar is reopened and special instruments are used to bring the latissimus dorsi muscle forward toward the breast. Ask your surgeon if this technique is suitable for you.

Less common types of flap procedures

If a TRAM, DIEP or LD flap is not suitable for you, techniques that use fat and a blood supply from other areas of the body may be offered. These include:

  • superior gluteal artery perforator (SGAP) flap or inferior gluteal artery perforator (IGAP) flap using tissue from the bottom
  • transverse myocutaneous gracilis (TMG) flap or transverse upper gracilis (TUG) flap using tissue from the inner thigh.

To help reconstruct a small breast shape, the surgeon may remove fat from another part of the body (liposuction), then inject it into the breast to create or improve the shape and contour. In some cases a whole new small breast may be built. This is known as lipofilling.

Risks of having a flap reconstruction

Hernia

The risk of having a hernia is higher for women who have a TRAM flap. This is because removing the rectus muscle can weaken the abdominal wall and cause a hernia, which is when part of the bowel juts out through the abdominal wall.

Inserting mesh into the abdomen to replace the muscle helps strengthen the abdominal wall. You will need to avoid heavy lifting for 6–12 weeks after the operation.

Loss of the flap

Blood vessels supplying the flap may kink or get clots, leading to bleeding and a loss of circulation. This may cause the tissue to die leading to a partial or complete loss of the flap. This is more common in women who smoke or have recently quit, although quitting smoking before surgery helps to decrease the risk.

In rare cases, the fat used to make a TRAM or DIEP flap doesn't get enough blood supply and dies. This is known as fat necrosis. The affected areas in the reconstructed breast can feel firm and are easily seen and diagnosed on a mammogram. They can be left in place or surgically removed. Women who smoke or have had radiotherapy are more at risk of fat necrosis.

Problems with donor site

After an abdominal flap reconstruction, some women find it takes a while for the wound to heal. After an LD flap reconstruction it's common for fluid to build up (seroma).

After the reconstruction you need to do some exercises to get your arm and shoulder moving properly again. Ask your nurse about what exercises to do.

Nipple adhesives and reconstruction

Some women decide they only want the shape of the breast reconstructed, others choose to have a nipple reconstruction to make their breast look complete. The appearance of the nipple and areola can be created in several ways.

Adhesive nipples

These stick to the skin and stay in place for several days. They are available from breast prostheses suppliers.

Nipple made from your own body tissue

A small operation can reconstruct a nipple and the areola. This operation is generally done several months after a reconstruction to give the original operation time to heal and because the reconstructed breast may sag slightly after surgery. Nipple reconstruction is done using tissue from your remaining nipple, if you have one, or with tissue from the new implant or flap. The new nipple won't have nerves, so it will not feel any sensation or become erect to touch.

Nipple tattoo

If you have a natural breast remaining, the new nipple can be tattooed to match the colour of the other nipple. Most reconstructive surgeons can do the tattooing or have a trained nurse do it, but you may prefer to have the nipples tattooed by a professional medical tattooist or beauty therapist. Initially, the tattoo will look darker than the remaining nipple, but it will fade with time to match in colour.

Woman with a reconstructed breast and nipple (no tattoo)

After the reconstruction you will have a new nipple.

Woman with a reconstructed breast and nipple (no tattoo)

Surgery to the other breast

For many women, the small differences between their remaining and reconstructed breasts are not noticeable when they wear a bra. For others, the difference in breast size may be more obvious. Some women decide to have the remaining breast made smaller or larger through surgery to match the reconstructed breast and improve balance and posture.

Bilateral mastectomy

Some women may be advised or choose to have a bilateral mastectomy. This means both breasts are surgically removed. A bilateral mastectomy may be recommended because of:

  • the type of breast cancer you have
  • your risks and/or anxiety about developing another breast cancer
  • family history or a gene fault that increases your risk for breast cancer the amount of surgery required to achieve a symmetrical result with the breast reconstruction
  • choosing an abdominal flap reconstruction but not being able to repeat the procedure if cancer develops in the other breast.

Reconstruction will need to be considered for both breasts. Discuss this issue with your doctor and seek a second opinion if you wish.

Therapeutic mammaplasty

This procedure combines a lumpectomy (lump removal) with a breast reduction. It is often used as an alternative to mastectomy in suitable cases. Usually a reduction mammaplasty is done on the other breast at the same time.

Taking care of yourself after a reconstruction

Your recovery time will depend on your age, general health and the type of surgery that you had. Most women feel better within 1–2 weeks and should be able to fully return to normal activities after 4–8 weeks.

Rest

When you get home from hospital, you will need to take things easy for the first weeks. Ask family and friends to help you with chores so you can rest.

Driving

You will probably need to avoid driving for 2–6 weeks after the surgery.

Tummy problems

After TRAM flap surgery you may have some weakness in your abdomen. Take care getting up from a low chair or sitting up in bed. You will be encouraged to wear supportive undergarments.

Lifting

Avoid repetitive arm movements, such as hanging out washing or vacuuming, and heavy lifting, including carrying shopping bags and lifting small children.

Follow-up appointments

Your surgeon will continue to care for you until your body has healed. Then you will have regular check-ups with your breast specialist. See more information on looking after yourself.

What to expect after surgery

The type of surgery you've had will affect the side effects you experience. Not all women experience these side effects, but most have one side effect or more.

Appearance of breast

It's natural to feel nervous when the bandages are first removed. The look of the reconstructed breast will improve as the bruising and swelling lessen. It may take longer for the appearance of a breast reconstruction using a tissue flap to settle. Your self-esteem is likely to be affected. See more information about Sexuality and Intimacy and Living Well After Cancer.

Pain relief

For any type of operation, you will be given pain relievers to ease your discomfort. You will also probably have small tubes inserted into the operation site so fluid can drain away. If you have had a flap reconstruction, you will be sore in the area where the muscle and other tissue were taken, as well as in the breast area.

Healing problems

Sometimes there may be healing problems within the first week or so after surgery. This can be caused by infection, poor blood supply or problems with an implant. Any infection must be treated to reduce the possibility of further complications. If an implant has been used, it might need to be taken out. However, it may be possible to have a new implant put in at a later date.

Bleeding

Blood may build up in or under the wound. This is called a haematoma, and it causes swelling and pain. A large haematoma may need to be surgically removed.

Seroma

In some cases, when drains have been removed, extra fluid collects in or under the wound. This is called a seroma, and it causes swelling and pain. It may need to be drained by a health professional using a needle.

Scars

All people heal differently and the final appearance of a scar will vary from women to women, even if the surgery is the same. Most scars have a thickened, red appearance at first, but usually fade after about three months.

Sometimes the scar stays thick and becomes itchy and uncomfortable. Let your surgeon know if you have other existing raised, irregular scars (sometimes called keloid scars), as this may show that you are prone to getting these types of scars. Your surgeon or breast care nurse can advise you about treatments to reduce the discomfort. You may be able to have further surgery to improve the scar's appearance.

Pregnancy

Breast reconstruction doesn't affect your ability to become pregnant or carry a baby. If you have had a TRAM flap reconstruction, mesh is put into the abdominal wall during surgery to help decrease the risk of a hernia during pregnancy.

Breastfeeding

It will not be possible to breastfeed with the reconstructed breast. Most women can breastfeed successfully with their other breast, although this may be difficult if you have had a reduction surgery in this breast. Talk to a breast care nurse or lactation consultant about any concerns you have about breastfeeding after a reconstruction.

Costs and financial assistance

Before you have surgery, find out how much it will cost to have a breast reconstruction. Check with your surgeon, the hospital, Medicare and your private health fund, if you have one, before deciding to go ahead. Find out whether you may need to pay for extras such as pain medicines, post-surgical bras and check-ups with your surgeon.

There are many services available for help with other costs associated with a reconstruction, such as transport costs to medical appointments and prescription medicines. Ask the hospital social worker which services are available in your local area and if you are eligible to receive them.

If you need legal or financial advice, you should talk to a qualified professional about your situation. Cancer Council offers free legal and financial services in some states and territories for people who can't afford to pay – call 13 11 20 to ask if you are eligible.

If you have your nipple tattooed, it is covered by Medicare if a doctor does the tattooing. If a professional tattooist does the work, it is not covered and you will have to pay yourself.

"With my private insurance, I was significantly out of pocket, due to the anaesthetist charging well above the schedule fee. However, the advantage gained with the reconstruction was well worth the cost." – Gwen

What to consider – reconstruction costs

Public hospital

  • Reconstruction after a mastectomy is a medical procedure, not a cosmetic one, so the costs are covered through Medicare for a public patient in a public hospital.
  • There may be some extra charges if an implant is used.
  • There may be some charges for private patients in a public hospital.
  • If you choose to have a delayed reconstruction, you will be put on the hospital's elective surgery waiting list. You may need to wait many months for the operation. Ask your surgeon about the likely waiting period.
  • You can put your name on a waiting list even if you're not sure that you want a reconstruction.

Private hospital

  • Private patients must have private health cover or pay the extra costs.
  • In a private hospital, Medicare will cover some of the surgeon's and anaesthetist's fees. Your health fund will cover some or all of the remaining costs, but you may need to pay a gap fee or a hospital admission fee.
  • Part or the entire cost of an inflatable tissue expander and any permanent implant may also be covered by your insurance provider.
  • If you decide to join a health fund before your operation, you will have to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with the different health funds.

Who will do the reconstruction?

If you choose to have a breast reconstruction, your own breast cancer surgeon may have the expertise to do this if they have training in plastic surgery techniques (this is known as an oncoplastic surgeon). Or, you may be referred to a reconstructive surgeon (also known as a plastic surgeon).

The breast cancer surgeon and a reconstructive surgeon may work together to do the breast cancer surgery and reconstruction during the same operation.

Ask your surgeon what to expect, about their experience and expertise, and about the risks associated with the different types of reconstructions. You can also ask to see photographs of their work.

Finding a surgeon

When considering having a reconstruction, ask to be referred to an expert in breast reconstruction. Check that they are a member of Breast Surgeons of Australia & New Zealand (BreastSurgANZ), and, if they are a reconstructive surgeon, a member of the Australian Society of Plastic Surgeons. 

Which health professionals will I see?

In hospital, you will be cared for by a range of health professionals who specialise in different aspects of a reconstruction procedure. Specialists and other health professionals will take a team-based approach to your care as part of a multidisciplinary team (MDT). The health professionals listed in the table below may be in your MDT.

Health professional
 Role
breast surgeon* specialises in surgery; some breast surgeons also perform breast reconstruction and specialised oncoplastic procedures
oncoplastic breast surgeon* specialises in using plastic surgery techniques to achieve a good cosmetic outcome after surgery
reconstructive (plastic) surgeon* performs breast reconstruction for women who have had a mastectomy
anaesthetist*
administers anaesthetic before surgery and monitors you during the operation
breast care nurse
specialist nurse who is trained in breast cancer care, including pre- and post- reconstruction counselling
occupational therapist, physiotherapist
assist in restoring range of movement after surgery and help with practical issues
social worker
links you to support services and helps you with any emotional, physical, practical or financial problems
counsellor, psychologist, clinical psychiatrist*
provide emotional support and help to manage feelings of anxiety and depression, and to help adjust to life after breast cancer

*specialist doctor

Question checklist

You may find this checklist helpful when thinking about the questions you want to ask your health care team about getting a breast reconstruction. If you don't understand the answers from the surgeon, it is okay to ask for clarification.

  • Do you think I can have a reconstruction?
  • When would you advise me to have the reconstruction?
  • Which type of reconstruction do you recommend for me, and why?
  • What are the possible problems with this type of reconstruction?
  • How long will I have to wait to have the procedure?
  • How long will I be in hospital and how long will my recovery be?
  • How much will it cost?
  • Am I covered by Medicare or my private health fund?
  • How will the reconstructed breast look and feel?
  • Do you have any photos of other women who have had this type of reconstruction?
  • Can I talk to other women who have had a similar operation?
  • Will the reconstruction hide any new problems?
  • Do I still need regular mammograms?
  • How can I get a second opinion?

Breast Cancer Network Australia has a number of personal stories about breast reconstruction.

Key points

  • The two main types of breast reconstruction operations are implant and flap reconstructions. Before making a decision, consider the benefits and drawbacks.
  • Both types of reconstructions can be done as an immediate or delayed procedure.
  • A number of factors, such as your body type, overall health, desired breast size, and whether you're having one or both breasts econstructed or any additional treatment such as radiotherapy, influence the type and timing of reconstruction.
  • Recovery after an implant or flap reconstruction can take several weeks. You may need more than one operation.
  • To recreate the nipple and areola some women use adhesive nipples, others recreate them surgically.
  • As with all operations, there are risks of side effects or the reconstruction not turning out as you had hoped. It may help to be realistic about the possible results.
  • Following a breast reconstruction some women say they feel better able to adjust to the changes in their body image.
  • A reconstruction is not likely to hide a cancer recurrence. You will still need to have check-ups with your doctors and regular mammograms.
  • Find out how much a reconstruction will cost before agreeing to the procedure. You may have out-of-pocket expenses.
  • A reconstruction can be done by an oncoplastic breast surgeon or a reconstructive (plastic) surgeon.

Reviewed by: A/Prof Elisabeth Elder, Specialist Breast Surgeon, Westmead Breast Cancer Institute and Clinical Associate Professor, University of Sydney, NSW; Jo Cockwill, Consumer; Suzanne Elliott, Consumer; Bronwyn Flanagan, Breast Care Nurse, Brightways, Cabrini Hospital, VIC; Maina Gordon, Consumer; Gillian Horton, Owner and Corsetry Specialist, Colleen’s Post-Mastectomy Connection, ACT; Kerry Nash, Sales and Marketing Manager, Amoena Australia, NSW; A/Prof Kerry Sherman, Macquarie University and Westmead Breast Cancer Institute, NSW. We are grateful to Amoena Australia Pty Ltd for supplying the breast form images. The breast reconstruction images have been reproduced with permission from Breast Cancer: Taking Control, breastcancertakingcontrol.com © Boycare Publishing 2010. 
Updated: 01 Jun, 2017