How Many Surgeries Does Breast Reconstruction Require?
There is a common misconception that breast reconstruction is complete after one surgery. Although the idea of having optimal outcomes after only one surgery sounds great, unfortunately this is rarely a realistic expectation.
The most commonly performed method of implant reconstruction involves placing a tissue expander at the time of the mastectomy (or any time later). The tissue expander is then “filled” with either saline or air over time (typically about 3 months) until the breast skin is expanded to the patient’s ideal breast size.
The tissue expanders will then be removed, and a permanent implant will be placed during a second surgery.
Some patients are candidates for what is called “Direct-to-Implant” surgery. This is where the permanent implant is placed at the time of the mastectomy without the need for a tissue expander. Although this sounds ideal, it is not always possible to achieve optimal cosmetic outcomes in one surgery. In about 30% of Direct-to-Implant cases, an additional “revision” surgery is needed to achieve the best aesthetic results.
Natural Implant Alternative Reconstruction (AKA “Flaps”)
Natural implant alternative breast reconstruction options (knows as “flaps”) represent today’s ‘gold standard’ for reconstruction. Tissue from one area of the body (lower abdomen, thighs, buttock and/or back) are transplanted to the chest wall using microsurgery to recreate a warm, soft, natural breast following a mastectomy.
Regardless of the type of “flap” procedure performed, a second “revision” surgery is typically performed about 3 months later to optimize results.
The “revision” surgery mentioned above is also know as “stage 2” reconstruction. Whether the patient underwent implant or flap-based reconstruction, the revision surgery is typically performed about 3 months after the initial reconstructive procedure is designed to fine-tune the reconstructed breast(s) in order to improve the overall cosmetic appearance. The revision stage will differ depending on the initial type of reconstruction and the patient’s goals, but commonly includes scar revision and fat grafting.
Patients whose nipples are removed during the mastectomy may also opt for nipple reconstruction as part of their breast reconstruction. This procedure can be performed during the “revision” surgery or at a later time due to medical necessity or choice.
Regardless of if nipple reconstruction is performed, nipple/areola tattooing is also an option for patients. Tattooing typically takes place about 3 months following the last surgical procedure performed.
In general, breast reconstruction typically requires 2-3 surgeries and/or procedures (including tattooing) over the course of about a year for optimal results regardless of which procedure a patient decides is best for their needs.
For a general snapshot of what to expect, we recommend reviewing our Breast Reconstruction Timeline.
Author: Dr. Minas Chrysopoulo and Courtney Floyd
Although the idea of having optimal outcomes after only one surgery sounds great, unfortunately this is rarely a realistic expectation.
I am wondering if this surgery is covered by my insurance. I have Medicare and my supplement is Champ VA.
Great question Vicki!
If your insurance covered your breast cancer surgery, they are required by law to cover your breast reconstruction surgery.