Lois W. Stern
Several months ago I read an article about some new options for reconstructive breast surgery. What was most startling to me about this article was the fact that although several new breast reconstruction options exist, patients are rarely told about them. One reason for this nondisclosure is that many plastic surgeons have not been trained in these latest breast reconstruction procedures. Another is pure economics. Whereas implant surgery is rather straightforward, some of these other surgical techniques are quite complex and can be far less profitable.

Typically a Manhattan surgeon bills an insurance company about $7,000 for a one-hour implant reconstruction, while some of the newer flap procedures require six to twelve hours of surgery, with an insurance reimbursement of $15,500. Based on an income/time expenditure ratio, there is little economic incentive for the surgeon to pursue these more complex procedures.

Breast implants are the most popular method of reconstruction in the United States. Often performed immediately after a mastectomy, a temporary balloon-like device called an expander is inserted under the skin to stretch it enough to accommodate the implant. It is a relatively simple procedure and the one with the shortest recovery time. But implants come with the potential for future operations because reconstructive patients are more likely to develop complications after implant surgery than cosmetic patients with healthy breast tissue. Clinical studies show that within four years, more than one third of reconstruction patients with implants had undergone a second operation, primarily to fix problems like ruptures and infections. Although complication rates for the newer flap procedures have not been well studied, many surgeons believe they are less likely to require follow-up operations.

Some of the newer, more complex breast reconstruction procedures are variations of flap techniques. The TRAM flap cuts away a portion of abdominal fat as well as underlying muscle containing blood vessels and then uses that tissue to rebuild a breast. The vessels provide a blood supply for the new breast mound. The procedure promises a more lifelike look and feel. The downside to the TRAM procedure is the risk of a weakened abdominal wall and possible hernia. Another flap method, the DIEP free flap, is the newest and most intricate. It involves moving abdominal fat and blood vessels, but because no muscle is moved, it is thought to reduce the likelihood of abdominal wall weakness. Not enough research has yet been done to evaluate the long-term efficacy of these flap techniques.

According to the American Society of Plastic Surgeons (ASPS), approximately 57,000 women in the United States had reconstructive breast surgery last year. Although it’s a safe bet to say that none of them chose their breast cancer diagnosis, they certainly have the right to informed consent in selecting their choice of reconstructive technique, if in fact they decide to undergo breast reconstruction. www.breastcancer.org is an excellent source for further information.

Lois Stern is the author of two books: Sex, Lies and Cosmetic Surgery , which has just been republished with an interactive CD and Tick Tock, Stop the Clock , as well as a number of magazine articles. She publishes a free monthly Health and Beauty Newsletter. You can sign up at:
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