Breast Reconstruction Frequently Asked Questions & Answers
by William Rigano, M.D.

1) What is the importance of Federal Legislation in 1998 for women's health?

All insurance companies have to cover breast reconstruction after mastectomy. They also have to cover procedures on the opposite breast to obtain symmetry, including reduction, augmentation and mastopexy. Recently, situations have risen where coverage for opposite-breast surgery after lumpectomy may be denied by insurance companies.

2) Is immediate or delayed breast reconstruction surgery best for me?

Most women are candidates for some type of immediate breast reconstruction. Since reconstruction is an additional major surgery, women should be carefully evaluated to understand all the risks and benefits. Multiple studies have shown tremendous psychological benefits to women who have immediate breast reconstruction.

3) What surgical options are available for breast reconstruction?

Women who desire to use their own tissue generally prefer the tram flap (abdomen) or a lat. dorsi flap (back) as a secondary choice.

Using tissue expanders to stretch the skin for implant use is a simple option; however, implants do get firmer and harder with time.

4) What is a tram flap?

A Transverse Rectus Abdominus Myocutaneous (TRAM) flap involves using skin and fat from the lower abdomen to rebuild the breast. The muscle is used to carry blood supply to skin and fatty tissue so volume can be replaced to match what is removed. The abdominal closure tightens the abdominal wall similar to a tummy tuck.

5) Are implants safe?

Yes, silicone implants are safe and can be used if your surgeon is involved with trials. Saline implants are extremely safe with very low infection or leakage rates. Soft tissue coverage over the implant is very important, so the implant is placed behind the chest muscle.

6) How do you find a surgeon who should perform breast reconstruction?

Ask your family doctor or patients of a plastic surgeon for referrals.

Look for credentials, experience and board certification in plastic surgery.

Obtain two or more consultations to compare surgeons.

Make sure your surgeon explains all the potential risks of the surgery and makes you understand ways to minimize those risks.

7) Does immediate breast reconstruction delay additional treatment for breast cancer?

No. The vast majority of patients who have immediate breast reconstruction can start chemotherapy within a month of the surgery. This time frame is not significantly different to women who only have a mastectomy. There is tremendous amount of plastic surgery literature that documents their benefits as well as the feeling of "wholeness" and improved psychological benefits.

8) How can women have the best breast reconstruction possible?

Seek out plastic surgeons that have extensive experience in flap reconstruction. By using one's own tissue, skin and volume can be replaced to match shape, size and softness.

Obtain a thorough plastic surgery consultation to evaluate all types of flap reconstruction; TRAM, VRAM (Verticle Rectus Abdominus Myocutaneous flap) and microsurgical flaps.

Even though these procedures are more extensive, their satisfaction to patients is very high in the long term.

For more information, contact Dr. William Rigano at (937) 293-3800 or visit his website at (abcsurg.com)