Breast Reconstruction - Implants & Nipple/Areola Tattoos

The Women's Health & Cancer Rights Act of 1998 says that if an insurance plan or coverage provides medical and surgical benefits for a mastectomy, then it must also include coverage for reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance, the prostheses (or breast implant), and any physical complications at all stages of mastectomy, including lymphedema.

After a mastectomy, many women choose to get breast implants. They help restore the psychological sense of being female as well as help clothing fit better, especially items that are fitted. Implants come in different diameters. Choose the diameter that fits your skeleton best. Implants come in different sizes, similar to cup sizes, but they are labeled according to how much fluid they can hold. The plastic surgeon should have some samples to see.

One type of implant is a saline implant. It has a clear silicone shell that looks like a balloon and is filled with a sterile saline solution (salt water).

Silicone implants are the other option. For several years they were off the market because of public concerns that the silicone gel inside might leak and cause immune system problems. Subsequent studies have shown that silicone gel implants do not increase the risk of immune system problems and so they are once again available.

There are two approaches to breast reconstruction:

1. One-Stage breast reconstruction can be done right after the mastectomy when the skin is preserved. After the surgeon removes the breast tissue, a plastic surgeon steps in and places the implant where the breast tissue used to be.


2. In Two-Stage reconstruction, the skin and chest wall are tight and flat after the mastectomy. First, a deflated "tissue expander" is put into place. Think of it as a temporary implant. It's job is to slowly stretch the skin, making it ready to receive the permanent implant. The expander has a tiny valve that the surgeon injects a little bit of saline solution into during several visits over time. Once the skin over the breast area has stretched enough, there is a second surgery to remove the expander and put in the permanent implant. Some expanders can be left in place as the final implant. Two-Stage reconstruction also allows for the option of waiting until after radiation treatment to begin reconstruction.

Things you should know about implants:

• Implants may not last a lifetime. They usually come with a "warranty" for a certain number of years but might need replacing in the future. That means surgery again.


• There might be complications from any surgery such as scarring, pain and infection.


• Contact sports and activities are no longer allowed because a blow to the chest can cause a break or leak to the implant.


• Capsular contracture (hard scar tissue around the implant) might occur. The plastic surgeon will show the patient massage techniques to counteract this during the healing process but it's not a 100% guarantee. Only a few people have this problem.


• The end result might not be the "beautiful breasts" that one dreams of. It's a reconstruction, not a recreation.

A word about nipples- believe it or not, new nipples/areolas can be tattooed on. Yes, the surgeon can do this! There is a little bit of post-operative care but it's easy.