Dr. Aboutanos Answers 8 Breast Reconstruction Questions

After a breast cancer diagnosis, it is common for your surgeon to recommend either a lumpectomy or mastectomy—but the questions you may have certainly don’t stop there. The goal of breast reconstruction is to help you feel whole, whatever that may look like in your unique situation.

Below, board certified plastic surgeon Dr. Sharline Aboutanos provides answers to questions she frequently hears from patients in her Richmond breast reconstruction consultations.

Do I have to get a breast implant during reconstruction after mastectomy?

No, you do not have to get a breast implant; reconstruction can be performed with either your own tissues or an implant. (And, of course, breast reconstruction with any method is optional—your physicians should support whatever choice you make.) 

Breast reconstruction using your own tissues involves transferring tissues from another part of the body to the breasts. Many women prefer this method so that the tissue is their own and there is no long-term maintenance or follow-up surgery required (breast implants are not lifetime devices, and may require surgery to be replaced or removed over time). There may also be some cosmetic benefits in the “donor” area where tissue is removed, i.e. some abdominal flattening. 

Still, natural tissue breast reconstruction has a more involved surgery and recovery process than implant-based reconstruction, so it’s a good idea to explore all of your options with your care team.

How many surgeries are required for breast reconstruction?

Breast cancer surgery and reconstruction may involve one, two, or three operations, depending on your anatomy, needs, and preferences. Many patients are good candidates for simultaneous breast reconstruction, the term we use for a single-surgery reconstruction. If surgery is instead phased out in two steps, mastectomy or lumpectomy is performed first, and reconstruction second. If you need three or more procedures, rest assured that the final procedure is likely to be relatively minor compared with the initial operation. Nipple tattooing is a recommended final touch to give you more natural-looking results.

Your plastic surgeon will tell you if combining the most significant surgeries (mastectomy and reconstruction) into one is possible. While this can be a great way to feel like yourself more quickly, focus instead on your surgeon’s recommendations for getting the best results. For example, a breast cancer patient who is planning to get implants may require “breast expanders” to help their limited remaining chest skin stretch to accommodate the implants. In this case, the first surgery would include both the mastectomy and placement of a breast expander, followed by a second operation to place a breast implant.

Can I wait to have reconstruction later?

Reconstruction can happen at any time after your mastectomy or lumpectomy. Some patients may wait months or even years later to undergo reconstructive surgery. 

The benefits of having reconstruction at the same time as mastectomy is that you may only have to undergo a single surgery and anesthesia process, and you do not have to spend time without a breast mound. Not having a breast mound may make clothing fit differently and otherwise cause some distress or inconvenience—though prosthetic breasts can be worn under a bra; this is a common choice for patients who have had breast oncological surgery.

Reconstruction can happen at any time after your mastectomy or lumpectomy. Some patients may wait months or even years later to undergo reconstructive surgery. 

Does health insurance cover breast reconstruction?

Yes, health insurance plans are required to cover breast reconstruction if they also cover mastectomy or lumpectomy, including if your reconstruction is delayed.

Who will perform my breast reconstruction?

While a breast surgeon will perform your mastectomy or lumpectomy, a board-certified plastic surgeon is your best choice for breast reconstruction; they will have been specially trained in reconstructive breast surgery techniques and be able to safely provide aesthetically pleasing results. Your breast surgeon and plastic surgeon will confer, recommend a plan, and coordinate the steps in your mastectomy and reconstruction process.

Do I need mammograms after breast reconstruction?

No, experts do not recommend routine mammograms to the reconstructed breast(s) after mastectomy; however, a mammogram is recommended after 6-12 months if you had lumpectomy or partial mastectomy. 

You will be encouraged to conduct weekly breast self exams and receive annual exams from your surgeon. If there is a concern found during a physical exam, a scan may be performed with mammogram, ultrasound, or MRI.

If you receive breast implants during reconstruction, know that silicone breast implants will need to be scanned at intervals with MRI or ultrasound to check for silent rupture. According to 2022 FDA recommendations, these scans should begin 5-6 years after your initial reconstruction, and then repeat every 2-3 years after that. (The same recommendations apply to patients who have cosmetic breast augmentation with silicone implants: while modern breast implants are very durable devices filled with cohesive silicone that will not migrate, it is important that their shells stay intact, and compromised implants should be replaced.)

How is breast reconstruction performed using my own tissues?

One method for using a patient's own tissue for breast reconstruction is called reduction lumpectomy. This surgery is only available to women who qualify for a lumpectomy to treat their breast cancer. After the lumpectomy, the remaining breast tissue is rearranged similar to a breast reduction. This avoids the need for an implant while also preventing an irregular breast appearance.

Will my breasts feel numb after reconstruction?

Some breast numbness is to be expected after reconstruction, and it’s unlikely to fully go away even years later. While this is normal, rest assured that an experienced, board-certified plastic surgeon will use the most advanced techniques available in an effort to preserve as much sensation as possible. Talk with your surgeon about the specifics of your case to learn what level of sensation will be normal for you after the procedure.

About female plastic surgeon Dr. Sharline Aboutanos

A board-certified plastic surgeon serving patients from Richmond and the surrounding areas, Dr. Sharline Aboutanos understands what women are going through during breast cancer treatment and breast surgery. As a female cosmetic and reconstructive plastic surgeon, she is here to work with you and your breast surgeon, listen to your goals, answer any questions that come up, and help you feel confident and whole again through reconstruction. To schedule a consultation with Dr. Aboutanos, call 804-355-3410 or contact us online.