Who is paying the costs of a breast reconstruction after cancer?

Since the breast ablation was performed because of cancer and since the resulting body assymetry can result to body posture and balance problems, the health insurance covers all the treatment expenses. This means that the health insurance will cover all the costs required for the complete reconstruction of the breast which including the costs for the reconstruction of the nipple and areola. In the case you receive different information from doctors or from your insurance telling you otherwise, we recommend a free advisory discussion in our offices concerning breast surgery.

 

How long do I have to stay in the hospital?

Usually the patients stay from one week to about 10 days in our clinic after the operation of the breast reconstruction. The first night after the operation the patient will stay in the intensive care unit for a close monitoring of the tissue perfusion. The next day the patient is being transferred back to her ward where after a gradual mobilization she will be eventually as early as possible dismissed from the hospital.

 

Which operation is the best for me?

Every case after the removal of the breast should be considered individually meaning that each time the appropriate operation should be always chosen according to the particular patient. Intensive discussions concerning the wishes as well as the fears of the patient should precede the operation so that common decisions about the treatment plan can follow. We promote the reconstruction of the breast using natural tissue from the patient’s own body because the advantages are more than when using silicone implants for the reconstruction. A breast reconstruction using the patient’s own tissue is better tolerated and has a better long term result. After a successful breast reconstruction with endogenous tissue no other complimentary operations are needed whereas with silicone implants there is always a need for an operation because of a possible capsular fibrosis and foreign body reactions. When comparing the different breast reconstruction procedures using endogenous tissue, various parameters should be considered. An important factor is whether the patient has and to what extent, residual breast tissue after the breast ablation. In cases where breast tissue is present, the reconstruction could be performed using the patient’s own fatty tissue. When the size of the opposite breast is small or the patient is really thin then the TMG procedure (transverse musculocutaneous gracilis flap) should be chosen the breast reconstruction. In the case of a more voluminous abdomen, the patient could be treated with the DIEP ( deep inferior epigastic perforator flap) procedure. In the case where the abdomen is not appropriate for such an operation because of previous operations in the same area, a S-GAP (superior artery perforator) flap could be performed using the fat rich areas of the thighs. The appropriate procedure should be discussed with the patient. Patients can also go through our big selection of pre- and postoperative pictures.

 

What are the dangers regarding microsurgical operations?

Often misinformed patients refer to the dangers and risks they were told concerning microsurgical operations that last many hours. Specifically, they refer to the DIEP, S-GAP or DMG flaps. These microsurgical procedures last longer that a breast reconstruction with an implant, about 4- 6 hours and not as long as 12-14 hours. During the procedure the narcosis (anaesthesia) is well tolerated with no unwanted reported reactions. Furthermore, the operation is performed in such a way that no considerable amount of blood is lost during the operation so that a blood transfusion is seldom required. In rare cases where the patients require blood, the patient can save his own blood before the operation and receive it if needed at a later time. In the case of healthy patients there are no higher risks when performing microsurgical procedures in comparison to breast reconstruction procedures using implants.

 

 I already had an abdominal operation (appendix, gall bladder, liposuction) . Am I an appropriate candidate for a DIEP procedure?

Principally a contraindication for a DIEP procedure in the case of previous abdominal operations does not exist. The estimation is made according to the type of the previous operation as well of the scar tissue left behind and its extent. After a tummy tuck (abdominoplasty) a DIEP procedure is not possible. After procedures like gall bladder or appendicitis operations and laparoscopies a DIEP procedure can follow with no complications especially when (as usually) small parts of the abdominal wall have been affected . During the planning and sizing of the flap , a part of the abdomen that has a scar from a previous operation can be harvested and then thrown away. After a liposuction the DIEP procedure is also possible.

 

Do I need a breast lift of the opposite breast after the breast reconstruction procedure?

Before the operation the doctor should discuss with the patient about the whole concept of the operation. The desired size of the breast to be reconstructed can be achieved through the performance of a microsurgical procedure using tissue from the abdomen, thighs or the lower leg in such a manner that no other measures(lifting of the opposite breast ) will be needed. When the patient so wishes, the size of the new breast can be smaller and firmer than before so that a breast lift of the opposite side should follow. Small assymetries can be resolved at a later time through liposuction.

 

Could the breast be reconstructed at the same time of the cancer-removing operation?

A simultaneously operation could be possible but that would mean that the procedure itself would last much longer. For that reason we prefer to perform the reconstruction at a second later time. There are though some cases where we could decide differently. The time plan of the operations should be with the patient defined according to her private, social und professional circumstances and obligations.

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