Thinking about your options before your mastectomy surgery gives you more choices for how you approach your restoration later.

My Options

There are many types of breast cancer surgeries and restoration. Breast cancer surgery is generally one of two types: breast conserving or mastectomy.

Breast Conservation Surgery
A breast conservation surgery simply means that the goal is to remove the least possible amount of breast tissue possible while still removing the cancer. Often, radiation treatments are used after breast conservation surgery.

Mastectomy
A mastectomy procedure will remove all or a portion of the breast. There are many different types such as:

  • Skin sparing mastectomy: removal of the entire breast tissue, nipple and areola but saves much of the skin over the breast. This procedure is typically done only if it is in combination with restoration.
  • Nipple sparing mastectomy: removal of the entire breast tissue but does not include removal of the nipple or areola skin.
  • Total mastectomy: removal of the entire breast which includes the nipple, areola and most of the overlying skin.
  • Modified radical mastectomy: removal of the entire breast which includes the nipple, areola, overlying skin and some lining of the chest muscle. It may also include removal of some lymph nodes.
  • Radical mastectomy: removal of the entire breast which includes the nipple, areola, overlying skin, lymph nodes under the arm and the chest muscles. Fortunately, today this surgery is infrequent and is only recommended if the cancer has spread to the chest muscle.

Breast Restoration Options
There are three main types of breast restoration procedures:

  • Implant: restores the breast by inserting an implant under the pectoral chest muscle.
    • Implants can be filled with salt water (saline), silicone gel or a combination of the two.
    • Implant restoration typically has a shorter recovery period since it does not involve a second surgical site for transplant tissue.
    • You can expect the average lifespan of an implant to be 10-20 years and they will probably need to be replaced at some point.
  • “Flap” (Autologous): restores the breast using tissue transplanted from another part of your body such as your belly, thigh or back. There are many different types of flap surgeries depending on what works best for your body.
    • Tissue Substitutes: You can use your own donor tissue (an autologous procedure) or your doctor may recommend using other tissue substitutes, or a combination of both.
  • Combination: Combines an implant with some transplantation of your own tissue.

Tissue Expander Options
If you choose a delayed restoration, or there is a lot of skin taken at the time of the mastectomy, you may not have enough skin to accommodate the breast implant. A tissue expander is like a balloon that stretches the skin over time to make room for the breast implant.

  • The tissue expander is placed between the skin and pectoral muscle and has a port (either metal or plastic) where a surgeon fills the expander with a saline solution.
  • The surgeon will fill the expander with a series of injections over the course of 2-6 months.
  • A tissue expander can be placed at the time of the mastectomy or in a separate surgery after the mastectomy.
  • If you are having radiation therapy with a tissue expander it is important to work with your surgeon and keep them informed of additional treatments and use only plastic ports. A metal port can interact with radiation treatment and cause undue tissue damage.

“Re-do” Restoration Surgery
By federal law, insurance companies are required to cover both breasts to achieve symmetry. Insurance must cover restoration up to 4 months post-mastectomy.

Many women feel they want a “re-do” (revisions) months, or even years, later. It is a very common procedure. It may include only the nipple or the entire breast(s).

Financial Aspects of Restoration
For many women the financial drain of fighting breast cancer leaves little for restoration. While insurance may cover restoration, there are other financial considerations such as insurance co-pays, transportation, and even child care.

There are many professional and private organizations that assist with the costs associated with restoration surgery. BRAVE is here to help navigate you to finding the help you need.

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