Breast reconstruction surgery in Boston, MA uses different types of surgery to rebuild the shape of one or both breasts so they appear as normal and symmetrical as possible following an operation to remove breast tissue.
- Who is Breast Reconstruction Surgery in Boston for?
- When does Breast Reconstruction Surgery happen?
- What does Breast Reconstruction Surgery involve?
- What are the benefits?
- How long does it take to recover from Breast Reconstruction Surgery in Boston?
- Are there serious risks to Breast Reconstruction?
- How much will it cost me?
Who is Breast Reconstruction Surgery in Boston for?
Breast reconstruction is usually carried out if a patient has had breast cancer.
It follows a mastectomy (surgery to remove the whole breast) or a lumpectomy (also known as breast-conserving surgery) that aims to remove the cancer while leaving as much normal breast behind as possible. A lumpectomy allows a patient to keep most of their breast but it increases the likelihood of them needing radiation treatment later.
One patient reports on realself.com that, “I had a lumpectomy in Jan and had a pretty big area removed which left me lopsided and a giant concave in my nipple….[the surgeon, Dr Hubbard] …was able to reconstruct the left breast and even them up….I am nothing but pleased with my results so far and its only been 8 weeks!”
Patients may also elect to have their breasts removed as a preventive measure known as bilateral prophylactic mastectomy. This is because they have a strong family history of breast cancer or they have the BRCA gene (harmful variants of which can increase the risk of cancer).
The American Society of Plastic Surgeons reported that their members carried out over 107,000 breast reconstructions in 2019 – an increase of 5% from the previous year – and up 36% from 2000.
But a plasticsurgery.com report in 2017 stated that that while the surgery has increased over time, less than half of women who require mastectomy are offered breast reconstruction surgery and less than a quarter understand the wide range of options available.
When does Breast Reconstruction happen?
Going through the loss of some breast tissue, or one or both breasts, is a very individual experience. It is difficult to anticipate how as a patient you will feel about the initial surgery, and then also about the prospect of breast reconstruction, and it is normal for feelings to change over time.
On the plus side, it is a decision that doesn’t have to be made straight away. Some people take their time weighing up whether they would like to “go flat” or use a prosthesis. Prosthetics help to fill the space left behind and provide relief for a patient while they adjust to the changes going on for them.
That said, some people decide to have breast reconstruction surgery at the same time as their initial procedure. This is known as immediate reconstruction and means they will come round from surgery with a restored breast shape. This may not be an option if treatments like radiation are needed and so patients need to check their options with their doctors.
Delayed reconstruction can happen months or years after the initial operation – perhaps after treatments like chemotherapy have been delivered. Hopkinsmedicine.org reports that whether it’s 20 days or 20 years since the initial surgery, the vast majority of breast cancer survivors are good candidates for reconstruction.
Delayed-immediate reconstruction sounds confusing – but it is useful for patients who would like to delay because they’re still making up their mind or because they are undergoing therapy. The procedure involves inserting a tissue expander into the site that stretches the skin ready for later reconstruction.
What does Breast Reconstruction surgery involve?
There are several different surgical routes to choose from and the decision should be made in partnership with your doctors so that you fully understand what might be best for you. Often, reconstruction involves more than one procedure.
The American Cancer Society says that among other factors, the choice is influenced by your health, the type of breast cancer surgery you’ve had, how much tissue you have available and your insurance coverage (see later).
Breast implants present the first option and this involves the same types of implants (saline or silicone) as cosmetic augmentation surgery. As such, they carry the same risks and benefits.
One patient says she is very happy with the result of breast reconstruction after a double mastectomy, “2 months out from tissue expanders being replaced with silicone high profile implants….Really had zero pain, recovery time was very short, I didn’t need one painkiller, and now 8 weeks out I’m back to gym.”
Secondly, flap (or autologous) surgery uses the patient’s own tissue to restore the breast, much of which can be done at the same time as the initial surgery – although sometimes, according to the Mayo Clinic, surgery can be delayed.
Realself.com explains that tissue is taken from another place on the body, including the abdomen (TRAM or DIEP flap), the upper back (Latissimus dorsi flap, the buttocks or hip (SGAO flap) and the inner thigh (TUG flap).
One patient of Texas surgeon, Dr Steele, was diagnosed with breast cancer and opted for bilateral mastectomy with immediate reconstruction. She said, “[the surgeon] created nipples, harvested fat from my abdomen and muffin tops and grafted into the areas of my breasts that had hollowed out….I am pleased with the results”.
What are the benefits?
The physical and psychological benefits from breast reconstruction are well known. Patients talk about breast reconstruction taking them from fear and uncertainty and towards hope, allowing them to feel “whole” again.
95% of patients on realself have rated the procedure as “worth it” with the DIEP flap procedure getting the thumbs up in 100% of reviews.
One of the reasons is likely to be because there a so many options open to patients to achieve the look they would like to achieve, and often, no pressure to make any decisions at the time of the initial cancer surgery. Flap surgery can often achieve a natural result and act more like natural breast tissue while cancer.org reports that most women do well with implants.
How long does it take to recover from Breast Reconstruction Surgery in Boston?
The length of stay in hospital after surgery, according to pennmedicine.org, depends on the kind of reconstruction chosen. After implant surgery, discharge is usually within two days and with the flap procedure it’s more within five days.
Recovery can take six weeks with support needed beforehand for daily activities like shopping. Patients can return to work at this point after taking advice from their doctors and one year after surgery, patients can usually stop seeing the surgeon for regular check ups.
Are there serious risks to Breast Reconstruction?
Patients should talk to their doctors about the usual risks associated with surgery that include infection, scarring, the wound not healing properly and suffering problems from the anaesthetic.
According to plasticsurgery.org, flap surgery also includes the risk of partial or complete loss of the flap as well as a loss of feeling at the site from which the tissue has been taken as well as the reconstruction site.
Implants may cause breast firmness also known as capsular contracture and implant rupture.
Moreover, Breastcancer.org reports that while surgery rebuilds the shape of the breast, it doesn’t bring back feeling to the breast or nipple, although over time it may become more sensitive to the touch.
It’s also worth thinking about future breast screening. The American Cancer Society advises that those with implants find a facility that has experience doing mammograms on women with breast implants as they can make part of the breast tissue hard to see via x-ray.
How much will it cost me?
Reconstruction costs vary hugely and can reach tens of thousands of dollars depending on the number and extent of the chosen procedures.
The total cost includes, among other bills, the surgeon’s fee, hospital costs, fees for the anaesthetic and follow up appointments. As with other procedures, insurance doesn’t cover surgery which is deemed to be for cosmetic reasons.
The Women’s Health and Cancer Rights Act (WHCRA) lays out that group health plans and health insurance issuers that cover mastectomies must also cover certain post-mastectomy benefits including reconstruction. It should cover reconstruction surgery to create symmetry, breast prostheses and any physical complications arising from surgery.
nerdwallet.com advises it is up to you to check whether the surgeon you have chosen is in-network or out-of-network. Choosing an in-network doctor means a discount is applied to their negotiated fee and the patient pays the difference. An out-of-network fee isn’t subject to a discount, which usually means the patient pays more towards the final bill.
It’s also worth remembering that a doctor who accepts your insurance plan and being in-network are two different things – make sure you verify their network status before booking surgery.
There will also be out-of-pocket expenses to factor in as you’ll be liable for any deductibles or co-pays. Your provider can confirm what these are which will help you decide on the surgical route you’d like to take.
However, as a guide, here’s what some insurance companies say about coverage.
In their medical policy for Reconstructive Breast Surgery/Management of Breast Implants, Blue Cross Blue Shield of Massachusetts says that reconstructive breast surgery may be considered medical necessary after a medically necessary mastectomy which are most typically done as treatment for cancer. This may include an implant-based approach or the use of autologous tissue.
In their document, Cosmetic, Reconstructive and Restorative Services Clinical Coverage Criteria, Fallon Health defines reconstructive surgery as a procedure to improve or correct a physical functional impairment resulting from a prior surgical procedure or disease. Breast reconstruction surgery may be performed when a breast has been disfigured due to trauma or following mastectomy. This procedure recreates a breast with the desired appearance.
In their Medical Policy for Breast Surgeries, Harvard Pilgrim Healthcare states that policies are written to apply to the majority of people with a given condition but member’s clinical circumstances are considered when making “individual determinations”. Regarding breast construction, procedures they consider include prostheses, nipple reconstruction and immediate or delayed reconstruction.
MassHealth’s Guidelines for Medical Necessity Determination for Breast Reconstruction and Intact Breast Implant Removal lay out that coverage of breast reconstruction surgery is considered on an individual, case-by-case basis to determine if it is medically necessary. This is partly influenced by whether the surgery is “intended to correct, restore, or improve anatomical and/or functional impairments that have resulted from congenital anomalies, accidental injury, trauma, previous surgery including mastectomy or lumpectomy, therapeutic interventions (for example, radiation), or disease of the breast”.
What is and isn’t covered by your insurer may appear confusing, so it’s advisable to communicate directly with your provider – and your doctors – as soon as you can to clarify what is and isn’t deemed a medically necessary part of the procedure. In this way, you will be able to calculate what your surgery is likely to personally cost you and therefore which solution suits you best.
Surviving breast cancer surgery is an emotional journey and everyone’s response to it is individual. This also goes for the reconstruction surgery that follows. Some patients would like to restore their breast shape at the same time as their initial procedure while others would prefer more time to adjust and consider their options.
Visiting a selection of board-certified surgeons who have skills and experience in both implant and autologous techniques will go a long way in laying out the range of options on offer. And settling on the right doctor for you, and putting financial plans in place to pay for your surgery, should help to restore hope and confidence following an anxiety-making time.
As one patient says of Dr Cassileth and her team in California, “She completely rebuilt my breasts despite the scar tissue from the mastectomy, radiation and everything else…. This team saved my life and I never worried, not for a moment. That is priceless. Thank you, with all of my heart.”
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Though the content of this blog has been carefully prepared, the author of this content is not a medical doctor and the content has not been reviewed by a Board-Certified Plastic Surgeon.
Unless specifically stated, patients referred to in this blog have not received a Breast Reconstruction Surgery in Boston by Dr Mark Markarian. This blog does not endorse the work of any doctors or surgeons mentioned. Stories relating to patients’ personal experiences of the Breast Reconstruction procedure should be treated as anecdotal only. Information about costs and insurance policies are for guidance only and should not be treated as accurate after publication. It is advised that costs and policy details are checked with individual physicians and the relevant insurance company.
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