There are so many different things we hear repeated time and again about breast reconstruction. We hear about long procedures, the pain, the recovery, the cost, and we hear about all the things that can go wrong. Most of what we hear is absolute rubbish!
The saddest part is that this information has often been passed on from woman to woman, patient to patient, through peer groups and forums, from breast care and clinic nurses, and from well-meaning friends and family. Misinformation is so easy to propagate. Misinformation feeds on fears and anxieties, so it finds fertile ground to grow when it relates to breast cancer.
So, let’s talk about the common breast reconstruction myths we hear, and take a few minutes to debunk these dubious claims!
Breast reconstruction Myth Number 1: Breast Reconstruction often fails.
BUSTED: Breast reconstruction is very safe. No matter how a breast is reconstructed, the outcomes are reliable and reproducible.
DIEP flap breast reconstruction, which I consider the gold-standard, has a success rate for experienced surgical teams like mine of about 99%!
Interestingly, implant-based breast reconstruction has a much higher failure rate than autologous reconstruction. I say “interestingly” because many patients see me having been told that DIEP flap reconstruction is too risky, and that they should have an implant reconstruction instead!
From the data available in the literature, implant reconstructions fail about 10-15% of the time. And by “fail”, I mean that the implant has to be removed and is left out so that the patient has no breast reconstruction. This number goes up significantly when patients require (or previously had) radiotherapy. Obviously, a failed reconstruction in any circumstance is a disaster for the patient, and the an enormous challenge for the surgical team.
As always, the risk of failure is mitigated by working with your surgeon to develop a reconstruction plan that takes into account many factors including your breast cancer, your treatment, your body shape/type and your desires.
To be honest, with shared decision making and an open discussion, we should be able to offer all of our patients a plan for reconstruction with a risk of failure as close to zero as possible.
Breast reconstruction Myth Number 2: Breast Reconstruction costs a fortune!
BUSTED: It is sad that some surgeons choose to charge patients a not-so-small fortune for breast reconstruction surgery. I really wonder how these surgeons can sit in front of a patient and discuss the costs that they will have to bear. I do however understand how hard it can be for patients to question their surgeons when it comes to costs.
But, as I have discussed elsewhere, all I can really do is be transparent about what my patients are charged for my services.
At LOSA, I have chosen to prioritise my breast reconstruction work. I offer all forms of breast reconstruction on health fund “known-gap” schemes. Every fund (except NIB unfortunately) offers some type of gap scheme. I have explained gap schemes on these pages before (because they are actually quite hard to figure out), but the guts of it is that the out-of-pocket costs for patients on these schemes is limited to (depending on the fund) $500-$1000. This allows the patient to extract the maximum benefit from their health fund, whilst still being treated in the private system with all of the many benefits that entails.
The gap schemes cover the primary surgeon, the second surgeon (I always perform free flap reconstruction with a colleague to make the surgery faster and therefore safer), and the anaesthetists I choose to work with. Which means that if both surgeons and the anaesthetist agree to charge only the known gap ($500 x 3), then the cost to my patients for a DIEP flap reconstruction is $1500 out of pocket. This compares to the average out of pocket costs nationwide of about $15000 for DIEP flap surgery and a further $4000-$5000 for anaesthesia.
Sure, breast reconstruction can be expensive. But it doesn’t have to be. It shouldn’t be. Go see a surgeon who won’t charge you a fortune. Simple.
Breast reconstruction Myth Number 3: Breast Reconstruction surgery is long and risky.
BUSTED: Any surgery can be prolonged by unexpected circumstances. But this myth is an old one, and relates to the early days of free-flap breast reconstruction. Back then (and even during my training) I would see free-flap breast reconstructions taking 10, 12 or even 14 hours for a single breast!
Fortunately, things have changed. A lot!
As microsurgeons, we have improved exponentially over the last 15-20 years. Bear in mind that this is pretty complex surgery! But as our microsurgical expertise has improved, this has allowed us to focus more on efficiency and aesthetics. In the best centers in the world, DIEP flap surgery can be performed with a mastectomy for immediate breast reconstruction in about 2.5 hours. I am lucky enough to have worked at St Thomas’ hospital in London where this was a regular occurrence for us. We often performed 3 DIEP flap reconstructions in a single operating list!
I can’t claim to be as efficient back here on the Gold Coast (it takes more than just a fast plastic surgeon – there need to be systems and procedures in place from start to finish to allow such incredibly efficient surgery) but we are getting there.
Unilateral DIEP flap reconstructions take me about 4-5 hours, and bilateral reconstructions take perhaps 6-8 hours.
It will take time to develop our breast reconstruction service on the Gold Coast. To be honest, we have had to start from scratch. I was the first fellowship trained breast reconstruction surgeon on the Gold Coast, and fortunately I have now been joined by a colleague with similar training, allowing us to work together to improve the safety and efficiency of our breast reconstruction procedures. Before I returned from London what was being offered on the Gold Coast was incredibly limited! But we’re getting there!
Put it this way, if someone is prepared to spend 6-8 hours having a facelift or a “mommy makeover” then I reckon the same amount of time having a breast reconstruction is more than justifiable.
Breast reconstruction Myth Number 4: The recovery after Breast Reconstruction surgery is long and painful.
Alright, I will give this myth a little credit. Whilst I would still say it is a myth, I can’t claim that recovery after breast reconstruction is instantaneous.
What I will say though is that the idea that implant-based reconstruction is somehow “easy” and fast, is wrong.
The idea that recovery after a DIEP reconstruction is longer and harder than an implant reconstruction is wrong.
The truth is that the recovery is different but different does not mean harder/worse. These are the myths we hear repeated time and again.
As a rule, major procedures like breast reconstruction (no matter the method) require a recovery period of about 6 weeks. Any surgical procedure of similar magnitude has a similar recovery. And like any other procedure, some people bounce back better than others. I have certainly seen patients who have had DIEP flap reconstruction running around much sooner than other patients who have had implant reconstruction, and vice versa.
Should the expected recovery after breast reconstruction discourage you from considering it? No, of course not. If you go into these things aware of what to expect, you’ll often be surprised how easy it can actually be.
Breast reconstruction Myth Number 5: Breast Reconstruction requires long hospital stays.
BUSTED: We still hear patients asking how many weeks they will be in hospital. Seriously. Unfortunately, many patients are being told that they will need “2 weeks in hospital” after their “14 hour surgery” by possibly well-meaning, but ill-informed people who actually work within the hospital and cancer-treatment systems. We’re talking breast care nurses, clinic nurses and breast surgeons. This honestly baffles me.
Most breast reconstruction requires an initial hospital stay of 3-5 days. That’s it.
After DIEP flap surgery, there is certainly a slightly more intensive period of close observation for 2-3 days than with implant reconstruction. But both methods of breast reconstruction will typically have similar requirements for time spent in hospital. Most patients will go home with a drain (or maybe two) but this is simple to manage, and being at home in your own bed is always better than a hospital bed.
Most breast reconstruction patients will require revision surgery at some stage. Ladies who have had DIEP flap breast reconstruction may opt for nipple reconstruction or minor scar corrections. Patients with implant reconstruction will require implant exchanges, fat grafting and other procedures. In almost all cases, these revision operations are day-surgery, meaning there is no need for overnight stays or further hospitalisations.
Well, I hope that helps clear a few things up. For more information, check out our breast reconstruction page, or search for “breast reconstruction” to see all of the blog posts covering the full breadth of breast reconstruction options