Breast reconstruction is completely covered under OHIP
What is breast reconstruction?
Reconstruction of a breast that has been removed for the treatment of breast cancer or to lower the risk of a high-risk individual can be one of the most rewarding procedures performed today. Breast reconstruction can be done immediately at the time of mastectomy or in a delayed fashion, months to years later. Many options are available and include the use of breast implants, your own tissues or combinations of both.
Breast reconstruction is elective surgery that involves recreating a breast which has been removed in part (lumpectomy) or in its entirety (mastectomy). This is usually secondary to treatment of cancer or prophylactic removal of the breast for patients who are at high risk of developing breast cancer (strong family history or BRCA gene mutation). Breast reconstruction is completely covered under the Ontario Health Insurance Plan (OHIP). This includes any balancing procedures or revision surgery in the future.
Who is breast reconstruction right for?
While there are many types of breast reconstruction, it is important to note that not all women are candidates for each type of reconstruction. The option(s) available to you will be discussed in consultation with your surgeon. It is also important to understand that no method of breast reconstruction will recreate a breast that looks and feels exactly the same breast as the breast that was removed. In cases of one- sided (unilateral) reconstruction, the new breast will often look and feel different from the opposite side. In the case of a unilateral mastectomy, part of your reconstruction may involve additional surgery to match your unaffected breast to the reconstructed side.
Breast reconstruction is a personal choice. It can have both physical and psychological benefits, and will avoid the use of an external prosthesis. It can be a lengthy process requiring a number of surgeries and recoveries, and it is important that every woman is well informed and confident in their decision regarding breast reconstruction. For women with serious medical problems or advanced cancer, breast reconstruction may not be a reasonable option. Personal factors including your body shape and treatment plan (especially radiotherapy) will impact the options available to you for breast reconstruction.
What are my breast reconstruction options?
Reconstruction can occur either at the same time as a mastectomy (immediate) or months to years after the mastectomy (delayed). The need for other cancer treatment – including radiotherapy or chemotherapy – may impact the timing of your reconstruction. Not all women are candidates for immediate reconstruction, particularly if there is planned postoperative radiation therapy. In some cases a woman may choose to delay the decision and choose breast reconstruction in a delayed fashion.
There are two major categories of breast reconstruction: 1) Implant based reconstruction; and 2) reconstruction using your own tissue (usually from the abdomen). In some cases a combination of techniques using your own tissue (latissimus dorsi flap) combined with an implant may be offered. Each technique has a different length of surgery, recovery time, advantages and disadvantages.
The decision to proceed with breast reconstruction is a personal one. It is important that you are comfortable with your decision. Your surgeon will spend as long as necessary with you to ensure that you understand the options and ultimately your decision. Together with your surgeon, you will come to a decision after considering your breast size, breast disease, body shape, other health concerns, lifestyle habits, fears and goals. Of course, you will also have a detailed discussion of the risks and benefits of the procedures that are right for you.
What are the risks of breast reconstruction?
The most common problems that patients face following breast reconstruction are highly dependent on the type of reconstruction performed. In the short term, patients will have issues related to pain and recovery from surgery. Delayed (slow) healing can be a problem for some patients and minor asymmetries (differences between the two breasts) sometimes require additional minor surgery to correct. Long term potential problems should be discussed in detail with your plastic surgeon. As a general rule, you should understand the possible complication of implants as well as the complications from using your own tissues, the most common of which is weakness in the donor area as well as significant scars at these donor sites. Of course, all surgery will result in scarring and your surgeon will advise you on how to best manage your scar.
Recovery will vary significantly between patients and between types of reconstructions. In general, you can aim for return to normal activities by 2-4 weeks for implant-based reconstruction or 6-8 weeks if using your own tissues. Your recovery will be gradual from day one after surgery and your surgeon will guide you through this process.
Your plastic surgeon will follow you closely in the short term and continue to follow you at regular intervals long term. Depending on the type of reconstruction, you will likely have bandages that will remain in place until your first follow up visit. You may have intravenous pain medication if you stay in hospital and you will be given oral pain medications and antibiotics for your initial recovery at home. You will also likely have drains that can be removed at home by a home care nurse or during one of your follow up visits. Depending on the type of procedure and your support at home, it can be arranged for a nurse to come to your home at regular intervals to help with both drain care and bandages.
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