Medically reviewed by Allen Gabriel, MD, on September 23, 2019
Most breast cancer survivors (or “previvors”—those who have a predisposition to breast cancer) have the option of breast reconstruction after a mastectomy or lumpectomy. This holds true even for women who had cancer surgery decades ago.
Opting for the right type of reconstruction for your situation and finding the right surgeon to perform it are essential factors in restoring the look and feel of your breasts. Consultations are your opportunity to interview potential surgeons, find out which technique they’d recommend, and choose the provider who’s qualified to perform your procedure and instills confidence that your goals will be achieved. Consult with at least two plastic surgeons, so you can compare their answers and approaches.
Start by confirming that they’re certified by the American Board of Plastic Surgery, a crucial qualification guaranteeing they’ve undergone the most rigorous training and that they adhere to a stringent code of medical ethics. You can see a surgeon’s board certifications on their RealSelf profile.
Don’t be nervous about asking questions. Your surgeon should welcome the fact that you’re advocating for your own healthcare. “Asking questions is one of the best ways to ensure you and your doctor are on the same page,” says Dr. Allen Gabriel, a plastic surgeon in Vancouver, Washington. Also take note of how well they listen and seem to understand your goals. More questions will likely come up during and after your consults, but here are some of the most important, to get you started.
1. Am I a good candidate for breast reconstruction?
What to listen for: Some people—for instance smokers, those who are overweight, or people with chronic medical conditions, like diabetes, that are uncontrolled—are at increased risk of complications for all types of breast reconstruction surgery.
You may also need more time for your skin to heal and your immune system to bounce back, if you’ve recently had chemo and radiation.
Even if you’re physically ready for surgery, you may want to wait until you feel truly ready to make decisions about breast reconstruction or take on the physical challenge of the surgery—especially if you’ve already had several, as part of cancer treatment. An ethical plastic surgeon will suggest or at least welcome the option of delaying breast reconstruction.
Keep in mind that there’s no age limit for breast reconstruction. “As long as you’re healthy and any conditions you have are well-controlled, a treatment plan can likely be achieved,” says Dr. Gabriel.
RealSelf Tip: If you haven’t yet had a mastectomy and don’t need further cancer treatment, you may be a good candidate for immediate breast reconstruction, which happens in the same session with mastectomy.
2. Which type of breast reconstruction would you recommend for me?
What to listen for: There’s no one best reconstruction method. Every woman’s situation is different, and there are pros and cons to both implant-based reconstruction and “flap” surgeries (which use your own tissue to recreate the breast). Breast implants are less invasive, because they don’t require taking tissue from donor sites—but the results may look and feel less natural. Some surgeons also recommend a combination (especially if you’ve lost a significant amount of tissue and skin) including fat transfer, to compensate for volume that may have been lost or just to create a more natural feel.
Not every option is available to every patient either. Some women are too thin to have enough donor tissue for certain types of flap surgeries. Others aren’t open to the idea of implants, because they have concerns about safety. As each plastic surgeon gives you their take on your reconstruction options, keep in mind that most will recommend only the techniques they’ve been trained to perform. If you’re interested in flaps, which involve microsurgery, you may need to seek out experts—even if that means going outside your local area.
If you’d like for your new breasts to look different from your old ones, now is the time to say something. “Ask yourself, ‘In an ideal world, what would I change about my breasts?’” suggests Dr. Gabriel. “Size and shape often come up, but you can also reconsider the position of your nipple and areola. Have an open and honest discussion about your goals with the plastic surgeon to make sure they’re realistic and achievable.” Dr. Gabriel also notes that some women are too overwhelmed and distracted with their cancer diagnosis to care too much about the future size and shape of their breasts. Especially if your surgeon recommends placing a tissue expander, he says, “sizing can be discussed at a later time.”
3. Do you work closely with a breast surgeon?
What to listen for: If you haven’t yet had your mastectomy or lumpectomy, look for a team approach to patient care, with reconstruction incorporated into your surgical treatment plan.
It comes down to having the breast surgeon and plastic surgeon understand and respect each other’s roles. “It’s the breast surgeon’s job to work hand in hand with the plastic surgeon to treat the cancer first yet not violate the aesthetics of the breast,” Dr. Gabriel explains. “The plastic surgeon’s job is to create a breast that’s esthetically pleasing. Treating cancer is No. 1, but we’re going to do everything we can to come up with any type of problem solving, any creative ideas to give the best possible cosmetic outcome for the patient, once they’re cancer-free.”
Ideally, your breast surgeon will be familiar with the latest techniques for skin- and nipple-sparing mastectomy, which will give your plastic surgeon much more to work with—and help preserve sensation.
4. How many of these procedures do you perform in an average month?
What to listen for: Surgeon experience is a key factor in successful outcomes. You want someone who does the procedure you’re interested in on a regular basis. “Repetition makes everyone better, including surgeons,” says Dr. Gabriel. There are no hard-and-fast rules about what number of procedures makes a surgeon proficient, but Dr. Gabriel says that when it comes to breast reconstructions, three to five a month is a good answer. Plastic surgeons who specialize in breast reconstruction may have much higher volume.
5. Will you personally perform my surgery?
What to listen for: It’s essential to confirm that the doctor you consult will actually be performing your surgery. In large medical groups or at university hospitals, surgical residents could participate in the reconstruction; but the plastic surgeon should do the procedure, from the initial incision to the final sutures.
6. Where will you perform my procedure?
What to listen for: Most breast reconstruction surgery is done in hospitals, which are accredited by an approved agency, such as the Joint Commission. That means the facility meets high patient-safety standards.
However, later stages of breast reconstruction—for instance, when the implant is placed after tissue expansion or autologous fat is grafted to improve the esthetic result—may be performed in an outpatient surgery center. If that’s the case, the facility should be accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the largest accrediting organization for office-based surgery, or another nationally recognized accrediting organization.
7. What kind of anesthesia will I have, and who will administer it?
What to listen for: Breast reconstruction is done under general anesthesia, meaning you’ll be asleep during the procedure. Anesthesia should be provided by a board-certified anesthesiologist or a certified registered nurse anesthetist (CRNA) supervised by an anesthesiologist. You should meet the person giving you anesthesia before your operation, to review your medical history—including allergies and any prescription or over-the-counter medications you take as well as any bad reactions you’ve had to anesthesia. They should also be present for the duration of your procedure as well as during your recovery immediately after.
8. Who will handle my follow-up care, and how will I get answers to any post-procedure questions?
What to listen for: You want to hear that your surgeon will directly monitor your healing during your follow-up visits until you’ve fully recovered. They’ll be supported by residents, physician’s assistants, and nurses. Ask your doctor about their follow-up protocol, how often you’ll be seeing them, and how any questions will be handled.
If you’re traveling for your procedure, ask the doctor doing your surgery to recommend a plastic surgeon in your local area who can provide follow-up care. Any surgeon who takes your care seriously should be willing to make this connection for you.
9. How do you handle complications?
What to listen for: If you have a problem after leaving the hospital (say, an incision opens or you develop an infection), you want to know that your surgeon will be available to provide care. Knowing there’s a plan in place and your surgeon is just a phone call away will give you peace of mind. If your surgeon—or their partner, if they’re not on call—isn’t going to be available at all times of the day, night, or weekend should you need help, it’s important to know who will provide emergency care and how experienced that person is.
10. What should I expect during recovery?
What to listen for: Some surgeries (such as flap surgeries that involve two or more sites) take longer to recover from than others, says Dr. David Reath, a plastic surgeon in Knoxville, Tennessee. Ask your surgeon how long it will take to heal from the specific surgery they recommend, including how long you’ll be unable to work, drive, or take care of your kids.
In addition, find out how you might physically feel immediately following the procedure—for instance, how much pain you should expect and how it can best be managed. Your surgeon will explain the postsurgical guidelines appropriate to your procedure and outline the arrangements necessary to ease your recovery.
The bottom line: “Breast reconstruction is major surgery and requires that you have a good support system in place for one to two weeks,” says Dr. Gabriel.
11. What happens if I’m dissatisfied with the result?
What to listen for: Most plastic surgeons will say that they’ll do whatever they can to get you a nice reconstruction result. But there’s no escaping the fact that the loss of breast tissue can create major aesthetic issues, so it’s important to manage your expectations. “Breast cancer treatment comes first,” says Dr. Gabriel. “There are things, such as scar placement, that we sometimes have no control over. Things can always be adjusted and concerns can be addressed, but correcting the issues may not always be possible.”
There’s some variation by location and insurance plan, but in most cases where your insurance covers a mastectomy or lumpectomy, multiple rounds of reconstruction revision procedures—from implant replacement to fat transfer to improve contours—should be covered, even a decade or more after your initial reconstruction.
12. Can I see before and after photos of your typical results?
What to listen for: A plastic surgeon should be proud to show you their work and gladly show photos of patients they’ve operated on. Just be sure to confirm that the photos are of the surgeon’s actual patients. “The cliché that a picture is worth a thousand words applies here,” says Greenwich, Connecticut, plastic surgeon Dr. David Greenspun. “Most experienced surgeons will have have a significant number of pre- and post-operative photographs that you can review, to get a better sense of what the results of reconstruction actually look like.”
In addition to providing a good feel for a surgeon’s aesthetic, looking at a large quantity of photos will give you an idea of how often they perform breast reconstruction—which can help confirm their level of experience with the procedure.
13. Can I speak with some of your patients who’ve had the same procedure?
What to listen for: “The answer should be an automatic yes,” says Dr. Gabriel. Besides wanting you to hear glowing reports from satisfied patients, plastic surgeons should welcome the valuable insight and support you can gain from speaking to someone who’s had a similar procedure.
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