I am having a lumpectomy on three lumps in my breast. They are not cancerous. I have a small B breast right now, and am nervous about how they will look after the surgery. What are my reconstructive options, and does insurance usually cover the reconstruction? I have BCBS.
Reconstructive Options for Lumpectomy?
Doctor Answers 5
Reconstructive options for lumpectomy?
Typically, implants in the setting of an irradiated breast has higher rates of complication, including infection, wound complications, capsular contracture, etc. Many surgeons, including myself, have placed implants to improve symmetry in these instances with excellent results. However, if your deformity is a contour issue with a soft tissue deficiency, placing an implant beneath the breast may actually worsen the deformity as it is not addressing the issue to "fill" the defect. For such problems, it may be a wiser decision to consider fat grafting for smaller defects, where fat is harvested for another area of your body and then reinjected into the defect, thus adding volume as well as having the added properties of fat graft stem cells. Autologous flaps such as local tissue, TAP, or LDMF may be needed for larger soft tissue defects. Of course, reduction of the other breast to create symmetry is an option, or a combination of procedures on both breasts. Typically, with a history of breast cancer, reconstruction is covered. Discuss options and insurance with your surgeon. Best wishes!
Reconstruction following lumpectomy
Lumpectomy, also called a partial mastectomy, segmental mastectomy or quardantectomy, is the surgical removal of a breast tumor along with some of the normal breast tissue that surrounds it. Depending on the breast size and shape, the amount of tissue removed to treat the cancer, and the changes that can occur in breast shape after radiation, breast-sparing procedures can leave the breast’s contours such that there may be no need for further reconstruction. Unfortunately, standard breast-conserving therapy has its limits and has been shown to yield poor cosmetic results up to 30 percent of the time. When many lumps have to be removed, a breast surgeon may recommend mastectomy for either oncologic or cosmetic reasons.
In spite of the potential aesthetic shortcomings, for many women, the ability to save a part of their breast makes the option of breast conserving therapy very appealing. Regrettably, some women may find that the shape of their breast treated with breast conserving surgery becomes distorted only after radiation therapy is completed. In such cases, delayed breast reconstruction may be able to improve the appearance of the breast and restore a more natural shape.
When a breast conserving procedure such as lumpectomy will or might distort the shape of a woman’s breast, a plastic surgeon can work together with a breast oncologic surgeon at the time of surgery, to help best preserve or restore the shape of your breast. Oncoplastic surgery combines innovative plastic surgery techniques with breast surgical oncology to maximize both the oncologic outcomes and cosmetic results of breast conserving surgery.
Since the options are vast, consultation and examination are really the only ways to find out which options would be best for a given patient. Furthermore, whenever possible, I suggest that women with breast cancer or DCIS/LCIS work with a breast management TEAM (this would include a breast surgeon, breast oncologist, plastic surgeon, and radiation oncologist). Since there are so many possibilities, a team approach can help assure that all aspects of a women's care are coordinated to help achieve the best possible outcome.
I hope this is helpful.
Lumpectomy and breast reconstruction
If you are having multiple lumps removed from your breast becuase of suspicion for a malignancy, then your reconstruction should be covered by insurance. There really are alot of ways to reconstruct your breast. It all depends upon the amount of breast tissue you started with, what you are left with, what post-op regimen is needed if they are malignant, etc..
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Options for breast biopsy and lumpectomy correction or reconstruction
In many instances surgeons will leave the lumpectomy spaces to fiil with fluid and frequently this will result in a minimal deficit. If, however, a significant amount of tissue volume is resected this could leave you with a more noticeable size difference. In this instance, opinions vary on how to manage the problem:
- Many would use a small implant
- Others would contemplate use of a local fat flap to rotate into the breast and compensate for the lost volume
- If radiation is not performed, some would consider use of fat grafting but this is somewhat controversial and not presently the standard of care.
Discuss your options with your surgeon and ask for a referral to a plastic surgeon.
Your own tissue or an implant
Oncoplastic techniques for managment of breast cancer gained a lot of support in Europe first followed by North America. The pendulum keeps swinging in surgical management of breast cancer between performing a mastectomy versus lumpectomy and radiation. One of the most important factors is the breast size removing thre lumps from a small B breast might not leave much tissue and a mastectomy reconstruction will yield a better result.
In your case as there is no malignancy the options for reconstruction are: Using an implant, fat grafting a latissimus muscle flap or a TRAM flap. Best of luck!