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1. When can I have breast reconstructive surgery?

   When you have your breast reconstructive surgery depends on your medical condition, psychological condition and any post-surgical treatment required. Many women can have an immediate breast reconstruction. But if you need post-surgical radiation, your doctor may prefer that you wait until treatment ends before breast reconstruction.

2. What types of breast reconstruction are available?

   There are two main forms of breast reconstruction: implants, which involve surgical implantation of a saline or silicone-gel-filled shell under the chest muscle, and autologous (tissue flap) breast reconstruction, in which a woman's own skin, fat and, in most instances, muscle are used to create a new breast. This tissue comes from the upper back, lower abdomen, thighs or buttocks.

3. Why would I need a two-stage breast reconstruction?

   If you have large breasts or there is not enough skin left after the mastectomy to cover an implant, you may require a two-stage breast implant reconstruction. The first stage involves placing a balloon-like tissue expander under the skin in the breast area, then adding saline every week or so for a month to several months to stretch the skin. This isn't painful but may be uncomfortable. After the skin is stretched enough, the expander is removed, and the permanent implant inserted in a second surgery.

4. What are the advantages and disadvantages of breast reconstruction with breast implants?

   The surgery and recovery time are shorter, and the procedure itself requires less specialized skill than autologous reconstruction. However, there is a greater risk of long-term complications from breast implants and, like other medical devices, breast implants—saline or silicone—are not lifetime devices. It is likely that at some point they may need to be removed or replaced. When a single mastectomy is performed, some patients opt for breast implant surgery on the other breast as well to achieve a more symmetrical look to the reconstructed breast.

5. What are the advantages and disadvantages of an autologous breast reconstruction?

   Autologous breast reconstruction is a much more complex surgical procedure, requiring more time in the operating room with the possibility for significant blood loss. It also requires a much longer recovery time than implants. However, autologous breast reconstruction results in a more natural-looking breast that lasts forever.

6. Can I have a nipple and areola added?

   Your surgeon can create a nipple and the surrounding dark tissue, called an areola, on your new breast. This is done as a separate, outpatient procedure after your breast reconstruction has healed, usually under local anesthesia. The nipple is usually reconstructed with a tattooed skin flap, with skin taken from your own body, such as from your opposite nipple, ear, eyelid, groin, upper inner thigh, buttocks, or the newly created breast. The areola is created with tattooing a few weeks later.

7. What if I don't want breast reconstruction now but change my mind later?

   As long as you are in good health, you can have breast reconstruction at any time.

8. Will my insurance cover the procedure? What if I don't have any health insurance?

   One thing you don't have to worry about is fighting with your insurance company to pay for the procedure. The 1998 Federal Breast Reconstruction Law requires all health insurance companies to cover reconstruction of the breast on which mastectomy has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance. If you don't have health insurance, talk to your surgeon and the hospital about negotiating a discount rate. You may also qualify for health insurance under your state's Medicaid program or other health-coverage programs for low- and moderate-income individuals.

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