The best hospital for breast reconstruction is the one that can help you feel comfortable and confident in your decision to undergo the procedure. In order to make an informed choice, it’s important to know what options are available to you. There are a variety of different kinds of reconstructive surgeries, as well as several different options within each type. Some women choose implants, but these can cause problems if they get infected or rupture. Others opt for tissue expanders—which are placed under the skin and gradually filled with saline until they expand to their final size—but this option can be very painful and requires that you have multiple surgeries over time.
Many women choose autologous tissue reconstruction, which involves removing excess skin from other parts of the body (like their abdomen) and using it to reconstruct their breasts after cancer treatments or other diseases have left them with little or no breast tissue remaining there. This type of surgery tends to be less expensive than other types because there’s no need for implants or tissue expanders; however, it does require additional surgeries over time and some patients may experience scarring at these sites where new skin grafts were taken from other parts of their bodies (such as legs).
Read on to learn more about Best Hospital For Breast Reconstruction, New Breast Reconstruction Techniques AND Breast Reconstruction Surgery Cost
Best Hospital For Breast Reconstruction
Breast reconstruction is a personal choice. There is no one “best” reconstruction for every woman. Instead, each woman will have her own best reconstruction, the one that she, in consultation with her doctors and perhaps her loved ones, feels is best. The following information is offered to help you make an informed decision.
Please feel free to ask your care providers any questions you may have regarding any of these reconstruction methods. These recommendations are meant only as general information. It is not designed as a substitute for a thorough discussion of your own case with your caregivers.
Timing of Breast Reconstruction
For many years, it was felt that breast reconstruction should be delayed for some time, usually six to 12 months after the mastectomy. That way, any tumor that returned could be detected.
More recent information indicates that breast reconstruction has no effect on finding a tumor that comes back and has no effect on your life expectancy. Since the women who choose reconstruction often feel better about themselves after breast reconstruction and because the surgeon often can do a better job if reconstruction is done at the time of mastectomy, immediate reconstruction is often recommended.
An additional benefit of immediate reconstruction is that it decreases the need for additional reconstructive surgery to complete your breast reconstruction. Therefore, if you are planning to have reconstruction, we advise you to have immediate (at the same time), rather than delayed reconstruction.
What Is Involved?
The goal of breast reconstruction is to provide the most natural looking and feeling breast possible, with as little discomfort to you as possible. In addition, to have a good cosmetic outcome, both breasts should look the same; that is, they should be about the same size and shape.
The breast consists of a “breast mound” and the nipple. Both the breast mound and the nipple can be reconstructed, although this is usually done at two separate surgeries. Part of the discussion should include the benefits and risks of changing the size of your other breast to create a better match.
What to Remember When Considering Breast Reconstruction
- In addition to considering the extent of surgery, it is important to consider the final reconstruction result.
- The flap procedures (TRAM flap and latissimus dorsi flap) result in a more natural looking and feeling breast than the expander and implant procedures.
- Not every surgery can be done in every woman for reasons that may be related to your tumor, medical condition or body shape.
- Any of the reconstructive techniques can be done at the time of the mastectomy or later.
- In addition to the information given here, you will need additional information based on your unique situation and medical condition. This will help you to select the best method for you and to understand the risks and benefits of your selected method.
What to Expect After Breast Reconstruction Surgery
- A sore throat. Although you will not have felt it at the time, nor remember it afterwards, you will have had a tube down your throat during the surgery. This can often cause a sore throat for a few days following your surgery.
- An oxygen tube in your nose.
- An intravenous (IV) line in your arm.
- Elasticized stockings on your legs covered by a Venodyne Compression device. This is a plastic sleeve that fits around the leg and is connected to a machine to mimic normal circulation. It is designed to prevent blood clots and will no longer be necessary when you are up and walking.
- Drains to remove excess fluids from the surgical area.
- Pain medication delivered by either an epidural (thin tube inserted during surgery into the fluid around your spinal cord) or through the IV in your arm.
- A urinary catheter will stay in for a few days until you are able to urinate on your own.
- Immediately after surgery, you will not be able to take anything by mouth.
New Breast Reconstruction Techniques
You might be having a mastectomy because you have breast cancer or to prevent the disease if it runs in your family. If so, you may also be considering breast reconstruction to rebuild your breasts, which isn’t a one-size-fits-all procedure. Some techniques use artificial implants, some use your own tissue. Others use a combination of both.
It can be difficult sifting through the choices to figure out what will work best for you. But the most important thing to know is that there are options, says Michele Manahan, M.D., an associate professor of plastic and reconstructive surgery at Johns Hopkins Medicine. “Breast reconstruction is not one-size-fits-all. Now more than ever we have so many ways to restore your form and make you look and feel like yourself again.”
A New, Less Painful Breast Implant Procedure
Manahan and her colleagues perform a state-of-the art procedure called pre-pectoral breast reconstruction. It reduces pain and provides a speedier recovery compared with traditional reconstruction by placing implants or tissue expanders on top of the pectoral muscles. Since the muscles aren’t cut or stretched, you can return to your normal daily activities sooner. “Our patients are doing yoga and have full range of motion within the first month after the procedure,” Manahan says.
The pre-pectoral procedure is the most minimally invasive breast reconstruction option. Your doctor can perform a mastectomy by removing breast tissue through a small incision underneath the breast. Through this incision, a tissue expander can be placed on top of the muscle to create a breast mound. Later, your doctor can remove the expander through the same incision and insert an implant.
A Natural Alternative to Breast Implants
Although using implants lets you recover faster, not everyone likes the way they look or the prospect of needing future surgeries to replace them if they rupture. A natural alternative involves using fat and tissue from another area of your body to fill in your breasts.
In the past, doctors removed muscle, fat and skin from the abdominal wall, the back, the inner thighs or the buttocks and moved it to the chest to form breasts. This procedure was painful and had a long recovery. But now an updated technique lets you use your own tissue with less pain and faster healing. During this surgery, called a perforator flap procedure, your surgeon moves only skin, fat and tissue — not muscle — to your chest area. Not everyone is a candidate for this procedure, depending on anatomy and previous surgical history, but it’s a good option for some women.
Using your own tissue creates a more natural look. And you can also have a tummy tuck, thigh lift or buttock lift at the same time if you have tissue removed from those areas.
Traditional Breast Reconstruction
The majority of breast reconstruction procedures involve breast implants. In this traditional reconstruction procedure, saline or silicone implants are placed below the pectoral muscles, forcing them to stretch to accommodate the implants. “This method works for a good deal of people, but many women experience pain as well as decreased range of motion in the shoulder,” reports Manahan. “Over time, chest wall deformities from the implants can form as well.”
What to Consider Before Breast Reconstruction
There are several things you need to consider when reviewing reconstructive breast cancer options, says Manahan. What procedure is best for you depends on many factors, such as:
- Overall health
- Activity level
- What you do for a living
- Whether you want to have children after surgery
- If you have the extra tissue needed for a natural reconstruction
- How much post-surgery downtime you’re comfortable with
If you’re going to have a lumpectomy or mastectomy, consult with a plastic surgeon in addition to your breast surgeon. A plastic surgeon can provide guidance on the various breast reconstruction procedures and work in partnership with your breast surgeon to give you the look you want.
It’s okay to take your time to come to a decision, says Manahan. “You might not know if you want implants, or whether you want to use belly or thigh tissue, or if you’re going to need radiation. But you can still move forward with the mastectomy. We can insert a tissue expander to hold a breast-like form under your skin. Then, when you’re ready, we can remove the expander and reconstruct your breasts with either implants or your own tissue. What’s important is knowing there are many options for breast reconstruction, and consulting with your surgeon to find the best choice for you.”
Everyone and every body is different, reminds Manahan, and every patient has different preferences and goals. “We hope that the many choices we have to offer for breast reconstruction will allow us to tailor each reconstruction to each individual patient.”
Breast Reconstruction Surgery Cost
Breast reconstruction comes in a wide variety of forms and the cost in the private sector is dependent on the stages of surgery, and type of reconstruction. Different types of breast reconstruction have different complexity and therefore different amount of time and effort required by the surgeon for your surgery.
It also depends on whether it is performed at the same time as the mastectomy or in a delayed fashion, and may also include costs for an anaesthetist, surgical assistant, hospital excess, and other fees. Usually, in the private sector, all fees are quoted inclusive of follow up both in hospital and in rooms after the surgery.
What is the cost of breast reconstruction in a public hospital?
In Australia, it is possible to have all forms of breast reconstruction in a public hospital free of charge, covered entirely by Medicare. Read what it means to be a public patient section of our website for more information. The main limitations of this option are:
– Possible increased wait time
– Less say of when and where your surgery will be performed with limited flexibility
– Registrars or fellows may be doing all or part of the procedure
– Follow up is generally in public hospital clinics, and wait associated with these
– Your date of surgery or supervising surgeon may be changed
Why is there is an out of pocket cost for breast reconstruction in a private hospital?
Despite having ‘top’ level of cover many patients ask why there is an out of pocket for procedures done in the private sector. This also applies to breast reconstruction. This is because the reimbursement or what Medicare and Health Funds pay is dependent on the schedule fee as listed for each Medicare item number. Unfortunately, the government has frozen this for decades meaning the reimbursement for each procedure is way behind what the actual cost of the procedure.
The Australian Medical Association each year publishes what it considers the fair value to be charged for each procedure and this is what many surgeons, including plastic surgeons, use to guide their fee structure. This means there is usually a ‘gap’ between the AMA fee and the Medicare schedule fee, and this constitutes the out of pocket cost. This often applies to both surgeon’s fees and anaesthetist’s fees.
While the main disadvantage of private treatment is an out of pocket cost, there are many advantages of private treatment:
– Total flexibility over time: often surgeons work with the patient’s time commitments and availability as to when to schedule the surgery
– Complete say over where your surgery will be performed
– Complete choice over surgeon and the main consultant surgeon performing your surgery
– Follow up is in private rooms with direct contact with the main surgeon who makes all the decisions
– Your date of surgery is usually fixed and won’t be changed (Unless negotiated with you)
What are the aims of breast reconstruction?
The aim of breast reconstruction is to:
– Create a breast mound
– Look great in clothes (even tight-fitting dresses)
– Achieve symmetry with the opposite breast (in cases of one-sided or unilateral reconstruction)
– Avoid the use of a prosthesis
What types of breast reconstruction are there?
There are 3 main categories:
- Implant or expander based breast reconstruction (i.e. using foreign tissue)
- Autologous breast reconstruction (using your own tissue only)
- Combination of autologous and implant or expander reconstruction – usually reserved for patients who have required radiation in their cancer treatment and do not have enough own tissue to make an entire breast
In general breast reconstruction is always a staged operation. This is often the case with implant reconstruction, which is often performed in 2 stages. Own tissue reconstruction is usually performed in a single stage but there may be a second stage for nipple reconstruction.