Should I have reconstruction at all?
Your first choice is whether or not to proceed with ANY reconstruction. For many years, mastectomies were performed without any chance of reconstruction. You may feel that the surgical procedures to restore your breast are not necessary and choose not to have breast reconstruction. This, obviously means less surgery and recovery. However, many women seek to avoid the disfigurement and sense of loss that a mastectomy may bring. It has been noted that women who go through less time without a breast seem to be less psychologically traumatized than those who wait longer for the reconstructive surgery.

When should you undergo breast construction?
There are two paths to choose from when deciding to have reconstructive surgery. Breast reconstruction may begin at the time of the mastectomy, in which case is known as "immediate breast reconstruction" or weeks, months, or years thereafter, also known as "delayed" reconstruction.

Immediate reconstruction: is performed at the same time as the mastectomy. Reconstructing the breast immediately following the mastectomy avoids additional operations and general anesthesia at a later date. Furthermore, the reconstructive process is generally easier due to the absence of scar tissue from prior surgeries with the breast skin retaining the size and shape of the original breast. In some instances, the breast cancer itself or other medical conditions may make immediate reconstruction unfeasible.

Delayed reconstruction: This is when the breast reconstruction is performed after the mastectomy, often after all chemotherapy or radiation treatment needed has been completed. This offers the quickest recovery at the time of the reconstruction.

What are my options for reconstruction
The three main types of reconstruction Dr. Mariotti performs are implant reconstruction, Latissimus flap (back flap) reconstruction and the TRAM (abdominal) Flap recontruction. The decision on which type of reconstruction to use in any patient’s case depends on many factors such as breast shape and size, body shape and weight, chance of radiation treatment, smoking history and a patient’s emotional state. Dr. Mariotti spend quite a deal of time helping his patient’s understand their options and help choose the reconstruction right for them.

Implant reconstruction: This is still the most common type of reconstruction. The recovery is the shortest, but does require another, relatively short, procedure later on. Dr. Mariotti places an expander under the skin and muscle and over several weeks, inflates the device by adding saline through a valve in the implant. Once it is large enough to match the other breast, it is removed and Dr. Mariotti places a permanent saline or silicone gel implant.

Back Flap Reconstruction: This is where Dr. Mariotti would use the skin and muscle from the back to reconstruct the breast. Depending on the size of the patient’s breast, an implant may also be used for volume. The advantage is that the woman will wake up with a full sized breast. The disadvantage is that the surgery lasts about an hour longer than the implant method, and a 2 or three day hospital stay is needed.

TRAM (Abdominal Flap) Reconstruction: This is where Dr. Mariotti uses the skin, fat and muscle from the abdomen to reconstruct the breast. The advantages include the ability to avoid any foreign material (implant) and the reconstructed breast has a very similar feel to the original breast. In addition, a tummy tuck is performed in order to gather the tissue needed for the new breast. The disadvantages include an additional 4 hours in surgery after the mastectomy, a 4 – 5 day hospital stay and a 4 – 6 week recovery.

Will my insurance cover the reconstruction?
Good News! Insurance companies are required by law to cover the cost of breast reconstruction at any time after mastectomy, including surgery to the opposite breast for symmetry if needed. This may include a lift or reduction on the other side, or, in some instances an enlargement.

Nipple / Areola Reconstruction
Once the breast mound has been reconstructed, the nipple can then be created. This is done using tissue that was transplanted during the reconstructive surgery as part of the breast mound creation. The color of the areola (areola = the pigmented circle around the nipple) can be added with a tattoo to complete the reconstructive process and to provide a very natural look. The nipple reconstruction is generally done approximately 2-3 months after the first breast reconstructive surgery and is an out-patient procedure