Breast Reconstruction Makes Breast Cancer Patients Whole Again After Mastectomy

Alarmingly, 70% of American women facing surgery for breast cancer are not told about the option of breast reconstruction.

Perhaps one of the best things about breast reconstruction is that it can be performed at any time….  you can never “miss the boat” so to speak. Regardless of the timing of the procedure, breast reconstruction enables women to feel whole again, not just physically but also emotionally.

There are several reconstructive options ranging from breast implants to using the patient’s own tissue. Tissue (or “flap”) procedures recreate a “natural”, warm, soft breast and are associated with fewer complications than breast implants.

Breast reconstruction can be performed at the same time as the mastectomy ("immediate reconstruction") or any time after mastectomy ("delayed reconstruction"). 
When the mastectomy and reconstruction are performed at the same time, a skin-sparing mastectomy can usually be performed which saves most of the natural breast skin envelope. Only the actual breast tissue under the skin is removed. The reconstruction then "fills" this empty skin envelope. In some cases nipple-sparing mastectomy can be performed. This preserves the nipple and areola as well as all the breast skin.



Skin-sparing (and nipple-sparing) mastectomy and immediate breast reconstruction produce the most "natural" results with the least scarring. Patients undergoing immediate reconstruction also avoid the experience of a flat chest altogether. Immediate reconstruction is therefore preferred whenever possible and should be the goal for patients with early breast cancer (stage I or II).

In some cases breast reconstruction cannot be performed at the same time as the mastectomy. Reasons include advanced breast cancer (stage III or IV), inflammatory breast cancer, the plan for radiation therapy after mastectomy, and lack of access to a reconstructive plastic surgeon.

As I already mentioned at the beginning of this post, most women unfortunately are not made aware of their breast reconstruction options. I therefore encourage all women interested in breast reconstruction to research their options and seek a referral or consultation with a plastic surgeon specializing in breast reconstruction.

You can see real patient results after immediate and delayed breast reconstruction in our photo gallery here.

Dr C


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PRMA Plastic Surgery specializes in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap reconstruction. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Finding the Best DIEP Flap Surgeon for You

If you are considering DIEP flap breast reconstruction, finding the right surgical team is key. Before deciding which surgeon is the best DIEP flap surgeon for you, consider asking the following questions:

1. Are you certified by the American Board of Plastic Surgery? Your surgeon should be a board certified plastic surgeon with extensive training and experience in microsurgery.
2. How much experience do you have with this type of surgery - How many have you performed? It is preferable that your surgeon has successfully performed over 100 DIEP flap reconstructions.
3. What's your success rate? Top specialist centers boast a success rate of at least 98%.
4. How long does the surgery take? This will vary between institutions based on experience. The most experienced surgeons typically take between 3-6 hours depending on whether one or both breast are being reconstructed (not including the mastectomies).
5. How often do you plan to perform a DIEP flap but end up changing the procedure to a free TRAM flap during the surgery? The "conversion rate" to a free TRAM flap should be very low.
6. How many microsurgeons will be performing the surgery? Since the DIEP flap procedure can be so technically demanding, it is preferable to have two microsurgeons performing the surgery rather than just one. Not only will this ensure you benefit from the expertise of two specially trained surgeons, but it will also significantly cut down the length of the procedure and anesthesia time.
7. Do you have residents or fellows? Will they be performing any of my surgery? Some centers have surgeons-in-training known as "residents" or "fellows" that may be helping with your surgery or even performing part of it. This may or may not be something you are comfortable with considering the complexity of the surgery. 
8. Do you "balance bill"? Centers like PRMA that are in-network for most insurance plans will ask the patient to pay ONLY what's laid out by the patient's insurance plan (ie copay, deductible, etc). Other centers "accept insurance" and will often help the patient get money back from their insurance company - however, the patient is still expected to provide the difference between what the insurance pays and the doctor's fee. This is known as "balance billing". Make sure to ask ahead of time to avoid nasty financial surprises down the line.
9. Do you have Insurance Specialists on staff? Unfortunately, some patients will face difficulties in gaining access to DIEP flap specialists even though insurance companies are federally mandated to pay for the cost of breast reconstruction. Here again it pays to seek out centers that specialize in these procedures as typically an insurance specialist is available to help patients with insurance issues. Again, this can prevent a nasty financial surprise after your surgery.

Hope that helps!

Dr C

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PRMA Plastic Surgery has successfully performed several thousand microsurgical breast reconstructions, and typically performs over 500 DIEP flaps per year. We specialize in advanced breast reconstruction procedures that use the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across and outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery.

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Will Insurance Pay For My DIEP Flap Breast Reconstruction?

"Will insurance pay for my DIEP breast reconstruction?"

This is a question I am repeatedly asked. The easy answer is "they should". However, some women have experienced difficulties with their insurance companies in terms of getting their DIEP breast reconstruction covered. Women must also be aware of "balance billing".

The good news is that there are a handful of plastic surgeons across the country that do routinely offer these advanced procedures and many of them accept insurance. Unfortunately most women will have to travel to gain access to them. We have posted an article on our website about finding a DIEP flap surgeon near you and which questions to ask.

Our group, Plastic, Reconstructive & Microsurgical Associates (PRMA) is located in San Antonio, Texas. We perform over 350 DIEP breast reconstructions per year, the vast majority of which are covered by insurance. We are in-network for most major US insurance plans and do not balance bill. We have insurance specialists on staff so our patients typically do not need to worry about the insurance side of things themselves.

Answers to more DIEP insurance FAQs can be found here.

Answers to more general DIEP flap FAQ's can be found here.

Dr C

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Dr Chrysopoulo, board certified plastic surgeon, PRMA Plastic Surgery, San Antonio, TX. Specializing in breast reconstruction surgery after mastectomy for breast cancer. Over 350 DIEP flaps performed yearly. In-network for most US insurance plans. Toll Free (800) 692-5565. www.prma-Enhance.com. Latest breast reconstruction news available at The Breast Cancer Reconstruction Blog.

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