Skin-Sparing Mastectomy: Reconstruction, Recovery, and More

Skin-sparing surgery is an option for many women who desire immediate reconstruction after mastectomy.

It’s a good choice if you’re undergoing prophylactic mastectomy (risk-reducing surgery). It might also be appropriate if you have early stage breast cancer. Most studies have found that there’s no increased risk of breast cancer recurrence with skin-sparing mastectomy.

The procedure isn’t for everyone, though. You can’t have skin-sparing mastectomy if you’re planning on delayed breast reconstruction or no reconstruction at all. In those cases, the excess skin must be removed to flatten the area and close the wound.

Additionally, the surgeon must be able to get clear margins, meaning there’s no evidence of cancer on or near the skin. You may not be eligible for this procedure if you have inflammatory breast cancer, multiple tumors, or a tumor too close to the skin.

With private insurance, mastectomy plus reconstruction can total as much as $90,000, or about half that if you’re on Medicare. Your out-of-pocket costs will be significantly lower than that.

Pricing any surgical procedure is difficult because of the many variables involved. Factors that affect total cost and out-of-pocket costs include:

• your health insurance plan and what the negotiated rate will be
• your deductibles, copays, and coinsurances
• whether the hospital, surgeon, and others involved in the procedure are in network
• where you live
• whether or not there are any complications

Most insurers cover the bulk of costs associated with mastectomy and reconstruction due to cancer.

The Women’s Health and Cancer Rights Act requires health plans that cover mastectomy to cover reconstructive surgery. Medicare covers reconstructive surgery, but Medicaid rules vary from state to state.

Before scheduling your surgery, contact your insurer so you know what to expect. Pre-authorization may be required. Most surgeons’ offices have an administrator to help navigate insurance and financial assistance programs or arrange payment plans.

There are a few ways to reconstruct a breast after skin-sparing mastectomy.

In abdominal-based flap reconstruction, sometimes known as a TRAM flap or DIEP flap, the surgeon takes skin, muscle, and fat from your abdomen, just below your navel. This tissue is then moved to your chest. Implants aren’t usually necessary, and using your body’s own tissues results in a natural, soft breast. You’ll have a long abdominal scar and two areas of your body that need to recover. TRAM flap reconstruction usually requires a few extra days in the hospital.

Alternatively, the surgeon can take muscle and skin from your back and combine it with a breast implant. This procedure is called latissimus muscle flap reconstruction. It will leave a long scar on your back.

With skin-sparing mastectomy, either a permanent or temporary saline implant is used. The surgeon usually places it under the pectoralis, a muscle in your chest. This is for added padding or protection of your implant.

Increasingly, artificial skin products are being used under the skin of the mastectomy as the additional layer instead of inserting the implant under the pectoralis muscle. If a temporary saline implant is placed in the mastectomy pocket, you’ll need another outpatient surgery to place a permanent implant.

If desired, an areola and nipple can be created in a future surgery. This is often done as an outpatient procedure. Some women prefer a tattoo in place of the areola and nipple, but tattoos may not be covered by insurance.

Your surgeon will provide home care instructions and schedule a follow-up visit.

When you go home, you might still have surgical drains in your chest. You’ll have to empty the drain and measure and record the fluid output. Your doctor will remove the drains after a week or two. You may need to wear a special bra during the healing process.

Plan on taking it easy and getting plenty of rest for the first few days. You’ll be given medication for pain and antibiotics to prevent infection. Your doctor may advise you to perform daily stretching exercises to improve flexibility.

Immediately following surgery, your breast will appear bruised and swollen. As the weeks pass, the swelling will go down and bruising fade. It may take up to eight weeks to truly see the results of your surgery.

Having a mastectomy can be an emotional experience. It’s hard to say in advance how you’ll feel — or how those feelings will change as you recover.

It’s not uncommon to feel sad, anxious, or overwhelmed during recovery, especially if you need additional treatments. These feelings are perfectly natural. Be honest with yourself and your loved ones, and give yourself plenty of time to work through these feelings.

Recovery time varies a lot from person to person. It usually takes from six to eight weeks, and sometimes longer, to resume normal activities.

Learn more: Preparing your postmastectomy wardrobe »

Surgery takes a toll on your body, so side effects are to be expected.

Here are some potential early side effects and potential remedies:

• Tiredness and difficulty sleeping: For chest discomfort, arrange pillows to keep yourself from rolling over during the night. Alternatively, try sleeping in a recliner. If you can, take a nap during the day.
• Pain and soreness of the chest, abdomen, or back: Your doctor may prescribe pain relievers or tell you which over-the-counter drugs are appropriate.
• Surgical drain discomfort: This is temporary. Your surgeon will remove the drains a week or two after surgery.
• Bruising and swelling of the chest: This will decrease over time.

In the long term, the scars on your chest, abdomen, or back will fade, but they won’t disappear. You can also expect your breasts to change as you age or when you gain or lose weight.

You can help your body recover with foods that promote healing, decrease inflammation, and provide energy.

Your post-surgery diet should consist of:

• vegetables and fruits
• whole grains such as brown rice, quinoa, and oatmeal
• lean proteins such as fish, poultry, eggs, beans, legumes, nuts, and seeds
• low-fat dairy products
• healthy fats such as olive oil, fish, avocado, wheat germ, and nuts

Go easy on butter and high-fat dairy products. Avoid deep-fried and processed foods that lack nutrients and sap energy.

Find inspiration: 8 Women proudly show the world their mastectomy scars »

Discussing your options with your doctor | Know your options

There are several types of mastectomy and reconstruction, and many factors to consider. Your doctor can make a recommendation based on your diagnosis and personal preferences.

Questions for your doctor:

• Is lumpectomy an option?
• What types of mastectomy can we choose from, given my diagnosis?
• What are the potential benefits, side effects, and complications of each?
• How long will it take to fully recover?
• Will it affect my other treatments?

Once you settle on a method of mastectomy, you can consider your options for reconstruction.

If you choose skin-sparing mastectomy, your reconstruction usually begins during the same operation. For other types of mastectomy, skin expanders can be put in at the time of surgery, and your reconstruction takes place in stages. You can also opt to delay reconstruction or skip it altogether.

Sometimes after your final cancer pathology is reviewed, your treatment plan could change, which may ultimately affect your reconstruction and its timing.

Consider these things:

• Do you want reconstruction or would you prefer prosthetics?
• Do you want to use only your own tissue or do you want implants?
• How do you feel about taking tissue from your abdomen or back?
• Are you up for multiple surgeries, or will that be too much for you?

It’s an emotional decision, as well as a medical one. Be open with your doctor. Ask questions and express your short- and long-term goals. Together, you can decide on the most appropriate treatment plan for your health and well-being.