Cosmetic Surgery Tips

Cost Of Breast Reconstruction After Mastectomy

The cost of breast reconstruction after mastectomy is often a concern for women who are considering the surgery. While there are many factors that factor into the final price tag, there are also ways to save money on this procedure.

There are two different types of breast reconstruction procedures: implant-based and flap procedures. Both have their own unique benefits and drawbacks, and the type of procedure you choose will depend on several factors, including your insurance coverage, your surgeon’s experience with one type versus the other, the size of your breasts before surgery, and other factors such as whether or not you have had radiation therapy or chemotherapy treatment for cancer in the past.

Implant-based breast reconstruction involves using an implant to recreate your breast tissue after undergoing mastectomy surgery. This option tends to be less expensive than flap procedures because there is no need for additional surgeries to remove tissue from another area in order to create new breast tissue. However, it also has its drawbacks: if you choose this option and want more volume later on down the line (for example, if you lose weight), then you would need to undergo another procedure in order to add more volume than what was originally provided during surgery.”

Right here on Cosmetic Surgery Tips, you are privy to a litany of relevant information on does insurance cover reconstructive surgery after mastectomy, your rights after a mastectomy, how much does a double mastectomy cost, and so much more. Take out time to visit our catalog for more information on similar topics.

Cost Of Breast Reconstruction After Mastectomy

Many women who have a mastectomy—surgery to remove an entire breast to treat or prevent breast cancer—have the option of having the shape of the removed breast rebuilt.

Women who choose to have their breasts rebuilt have several options for how it can be done. Breasts can be rebuilt using implants (saline or silicone). They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.

Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction). Delayed reconstruction can happen months or even years after the mastectomy.

In the final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.

Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.

How do surgeons use implants to reconstruct a woman’s breast?

Implants are inserted underneath the skin or chest muscle following the mastectomy. (Most mastectomies are performed using a technique called skin-sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.)

Implants are usually placed as part of a two-stage procedure.

In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle (1,2). The expander is slowly filled with saline during periodic visits to the doctor after surgery.
In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomy—that is, a tissue expander is not used to prepare for the implant (3).

Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or “sling” to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.

How do surgeons use tissue from a woman’s own body to reconstruct the breast?

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman’s body and used to rebuild the breast. This piece of tissue is called a flap.

Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.

Depending on their source, flaps can be pedicled or free.

With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
Abdominal and back flaps include:

  • DIEP flap: Tissue comes from the abdomen and contains only skin, blood vessels, and fat, without the underlying muscle. This type of flap is a free flap.
  • Latissimus dorsi (LD) flap: Tissue comes from the middle and side of the back. This type of flap is pedicled when used for breast reconstruction. (LD flaps can be used for other types of reconstruction as well.)
  • SIEA flap (also called SIEP flap): Tissue comes from the abdomen as in a DIEP flap but includes a different set of blood vessels. It also does not involve cutting of the abdominal muscle and is a free flap. This type of flap is not an option for many women because the necessary blood vessels are not adequate or do not exist.
  • TRAM flap: Tissue comes from the lower abdomen as in a DIEP flap but includes muscle. It can be either pedicled or free.
  • Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who don’t have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.
  • IGAP flap: Tissue comes from the buttocks and contains only skin, blood vessels, and fat.
  • PAP flap: Tissue, without muscle, that comes from the upper inner thigh.
  • SGAP flap: Tissue comes from the buttocks as in an IGAP flap, but includes a different set of blood vessels and contains only skin, blood vessels, and fat.
  • TUG flap: Tissue, including muscle, that comes from the upper inner thigh.
  • In some cases, an implant and autologous tissue are used together. For example, autologous tissue may be used to cover an implant when there isn’t enough skin and muscle left after mastectomy to allow for expansion and use of an implant (1,2).

How do surgeons reconstruct the nipple and areola?

After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. The procedure for creating a new nipple typically involves cutting and moving small pieces of skin from the reconstructed breast to the nipple site, then shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction (1).

Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.

A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts (4,5).

What factors can affect the timing of breast reconstruction?

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. In order to replace the radiation-damaged breast and chest wall tissue with healthy tissue from another part of the body, autologous tissue breast reconstruction is typically reserved for patients who have undergone radiation therapy.

Another factor is the type of breast cancer. Women with inflammatory breast cancer usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.

Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

What factors can affect the choice of breast reconstruction method?

Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the woman’s age and health, her history of past surgeries, surgical risk factors (for example, smoking history and obesity), the availability of autologous tissue, and the location of the tumor in the breast (2,6). Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.

Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.

Reconstruction with Implants

Surgery and recovery

Enough skin and muscle must remain after mastectomy to cover the implant
Shorter surgical procedure than for reconstruction with autologous tissue; little blood loss
Recovery period may be shorter than with autologous reconstruction
Many follow-up visits may be needed to inflate the expander and insert the implant
Possible complications

Infection

  • Accumulation of clear fluid causing a mass or lump (seroma) within the reconstructed breast (7)
  • Pooling of blood (hematoma) within the reconstructed breast
  • Blood clots
  • Extrusion of the implant (the implant breaks through the skin)
  • Implant rupture (the implant breaks open and saline or silicone leaks into the surrounding tissue)
  • Formation of hard scar tissue around the implant (known as a contracture)
  • Obesity, diabetes, and smoking may increase the rate of complications
  • Possible increased risk of developing a very rare form of immune system cancer called anaplastic large cell lymphoma (8,9)
  • Other considerations
  • May not be an option for patients who have previously undergone radiation therapy to the chest
  • May not be adequate for women with very large breasts
  • Will not last a lifetime; the longer a woman has implants, the more likely she is to have complications and to need to have her implants removed or replaced
  • Silicone implants may feel more natural than saline implants to the touch
  • The Food and Drug Administration (FDA) recommends that women with silicone implants undergo periodic MRI screenings to detect possible “silent” rupture of the implants
  • More information about implants can be found on FDA’s Breast Implants page.

Reconstruction with Autologous Tissue

Surgery and recovery

  • Longer surgical procedure than for implants
  • The initial recovery period may be longer than for implants
  • Pedicled flap reconstruction is usually a shorter operation than free flap reconstruction and usually requires a shorter hospitalization
  • Free flap reconstruction is a longer, highly technical operation compared with pedicled flap reconstruction that requires a surgeon who has experience with microsurgery to re-attach blood vessels.

Possible Complications

  • Necrosis (death) of the transferred tissue
  • Blood clots may be more frequent with some flap sources
  • Pain and weakness at the site from which the donor tissue was taken
  • Obesity, diabetes, and smoking may increase the rate of complications

Other Considerations

  • May provide a more natural breast shape than implants
  • May feel softer and more natural to the touch than implants
  • Leaves a scar at the site from which the donor tissue was taken
  • Can be used to replace tissue that has been damaged by radiation therapy
  • All women who undergo mastectomy for breast cancer experience varying degrees of breast numbness and loss of sensation (feeling) because nerves that provide sensation to the breast are cut when breast tissue is removed during surgery. However, a woman may regain some sensation as the severed nerves grow and regenerate, and breast surgeons continue to make technical advances that can spare or repair damage to nerves.

Any type of breast reconstruction can fail if healing does not occur properly. In these cases, the implant or flap will have to be removed. If an implant reconstruction fails, a woman can usually have a second reconstruction using an alternative approach.

Will Health Insurance Pay for Breast Reconstruction?

The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that requires group health plans and health insurance companies that offer mastectomy coverage to also pay for reconstructive surgery after mastectomy. This coverage must include all stages of reconstruction and surgery to achieve symmetry between the breasts, breast prostheses, and treatment of complications that result from the mastectomy, including lymphedema. More information about WHCRA is available from the Department of Labor and the Centers for Medicare & Medicaid Services.

Some health plans sponsored by religious organizations and some government health plans may be exempt from WHCRA. Also, WHCRA does not apply to Medicare and Medicaid. However, Medicare may cover breast reconstruction surgery as well as external breast prostheses (including a post-surgical bra) after a medically necessary mastectomy.

Medicaid benefits vary by state; a woman should contact her state Medicaid office for information on whether, and to what extent, breast reconstruction is covered.

A woman considering breast reconstruction may want to discuss costs and health insurance coverage with her doctor and insurance company before choosing to have the surgery. Some insurance companies require a second opinion before they will agree to pay for a surgery.

What type of follow-up care and rehabilitation is needed after breast reconstruction?

Any type of reconstruction increases the number of side effects a woman may experience compared with those after a mastectomy alone. A woman’s medical team will watch her closely for complications, some of which can occur months or even years after surgery (1,2,10).

Women who have either autologous tissue or implant-based reconstruction may benefit from physical therapy to improve or maintain shoulder range of motion or help them recover from weakness experienced at the site from which the donor tissue was taken, such as abdominal weakness (11,12). A physical therapist can help a woman use exercises to regain strength, adjust to new physical limitations, and figure out the safest ways to perform everyday activities.

Does breast reconstruction affect the ability to check for breast cancer recurrence?

Studies have shown that breast reconstruction does not increase the chances of breast cancer coming back or make it harder to check for recurrence with mammography (13).

There will still be mammograms of the other breast for women who have had a mastectomy on one breast. Women who have had a skin-sparing mastectomy or who are at high risk of breast cancer recurrence may have mammograms of the reconstructed breast if it was reconstructed using autologous tissue. However, mammograms are generally not performed on breasts that are reconstructed with an implant after mastectomy.

A woman with a breast implant should tell the radiology technician about her implant before she has a mammogram. Special procedures may be necessary to improve the accuracy of the mammogram and to avoid damaging the implant.

More information about mammograms can be found in the NCI fact sheet Mammograms.

What Are Some New Developments in Breast Reconstruction After Mastectomy?

Oncoplastic surgery. In general, women who have lumpectomy or partial mastectomy for early-stage breast cancer do not have reconstruction. However, for some of these women the surgeon may use plastic surgery techniques to reshape the breast at the time of cancer surgery. This type of breast-conserving surgery, called oncoplastic surgery, may use local tissue rearrangement, reconstruction through breast reduction surgery, or transfer of tissue flaps. Long-term outcomes of this type of surgery are comparable to those for standard breast-conserving surgery (14).
Autologous fat grafting. A newer type of breast reconstruction technique involves the transfer of fat tissue from one part of the body (usually the thighs, abdomen, or buttocks) to the reconstructed breast. The fat tissue is harvested by liposuction, washed, and liquified so that it can be injected into the area of interest. Fat grafting is mainly used to correct deformities and asymmetries that may appear after breast reconstruction. It is also sometimes used to reconstruct an entire breast. Although concern has been raised about the lack of long-term outcome studies, this technique is considered safe (1,6).

Cost of Double Mastectomy without Insurance

What is a bilateral mastectomy?

“Mastectomy” is a medical term that refers to surgical removal of the breast tissue. This specifically refers to the glands that produce milk within the breasts. These glands surround blood vessels that feed the skin which means that portions of the skin of the chest, including the nipples, also often need to be removed. 

A one-sided mastectomy is one of the most common treatments for breast cancer. A bilateral (two-sided) mastectomy is generally done if there is a significant risk of you developing cancer in the other breast, if you desire removal of the other breast for symmetry, or if you have a genetic condition (known as the BRCA gene) that gives you a nearly 60% chance of developing breast cancer at some time in your life. 

Bilateral mastectomies are also used for gender affirming surgery, this is the removal of the breasts to create a chest that has a more masculine appearance.

How is a bilateral mastectomy performed?

A bilateral mastectomy is performed by a surgeon while you are under general anesthesia (put to sleep). A surgeon will remove a wedge-shaped section of skin, as much of the milk producing glands as possible, and a section of the fat tissue within the breast. This open area created in the breast will then be stitched closed. 

There are other more advanced mastectomy methods that may be appropriate in special situations. These are still uncommon and are only appropriate for specific patients. Your surgeon will be able to explain these more advanced options and if they are appropriate for you.

How long is a hospital stay for a double mastectomy?

A hospital stay for a mastectomy is generally around 3 days. The majority of the first day is focused on pain control and ensuring that no complications develop from the surgery. The days after this are focused on physical therapy, education about wound care, and setting up follow-up appointments. 

You will be discharged from the hospital when your pain is controlled enough to allow you to perform daily tasks and care for your surgical wounds.

How long does it take to recover from a double mastectomy?

Full recovery generally takes several weeks.

  • The first week requires significant limitations in your activity, there will be many exercise and movement restrictions to protect the healing wound. 
  • The second week is focused on follow-up visits and monitoring your recovery. Your surgeon will provide more specific guidelines regarding your recovery at this time. 
  • The weeks after the second week vary greatly based on your age, health, and the amount of breast tissue removed. Generally 3 – 4 weeks after the surgery you can expect to return to most daily activities except intense exercise.

How painful is mastectomy recovery?

The first few days after the surgery are the most painful. Since a mastectomy generally only affects the skin and fat tissue, the deep cramping pain that comes from surgery on the muscles is limited. The majority of the pain is often described as a dull sensation in the skin and a sensation of fullness in the chest. This is controlled with several days of prescription oral pain medication, wrapping the chest to decrease swelling, and physical therapy to reduce the risk of chronic pain. 

After the first week the pain from the surgery will significantly decrease and can usually be managed with over the counter pain medications alone.

Can you still get breast cancer after a bilateral mastectomy?

It is nearly impossible to remove 100% of the milk glands within the breast as they are scattered throughout the fat that covers the chest. THis means that there is always a chance of cancer returning. Luckily, this risk is very low. 

Many lumps and bumps will develop over the years following a mastectomy as scar tissue from the surgery builds up in the breast. These changes should always be reported to a doctor as they will want to regularly follow-up to ensure they are not appearing or changing at a rate that would suggest a return of cancer.

Cost of Mastectomy

About the bilateral mastectomy Average Cash Prices

This procedure is most commonly performed at either a surgery center or an outpatient hospital.

Surgery centers, also known as ambulatory surgery centers (ASCs), are independent, licensed medical facilities that are governed by distinct regulatory requirements compared with a hospital. Procedures performed at an ASCs are often less expensive than when they are performed at an outpatient hospital, but they typically offer fewer complimentary services, and may not have the full-range of support services that a hospital provides.

Outpatient facilities are outpatient departments or clinics that may be within or next to a hospital, but is owned and run by the affiliated hospital. These facilities can perform surgical treatments and procedures that do not require an overnight stay. Procedures performed at an outpatient hospital are often more expensive than when they are performed in an ambulatory surgery center, but outpatient hospitals may offer more complimentary and support services for patients because they are connected to the hospital system.

Your actual costs may be higher or lower than these cost estimates. Check with your provider and health plan details to confirm the costs that you may be charged for a service or procedure. You are responsible for costs that are not covered and for getting any pre-authorizations or referrals required by your health plan. Neither payments nor benefits are guaranteed.

The site is not a substitute for medical or health care advice and does not serve as a recommendation for a particular provider or type of medical or health care.

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