Revised November 2001
Reconstructive Surgery
- Good information on this procedure is available from Vancouver Coastal Health.
- Surgical procedure following mastectomy which is an insured benefit under the provincial medical plan
- Aim is to restore a more normal contour when clothed, by recreating a breast mound. This is usually very successful
- Usually performed by a plastic surgeon rather than the surgeon who did the mastectomy
- May be performed as soon as the mastectomy scar has become soft and pliable or at same time as mastectomy (immediate reconstruction)
- The silicone gel-filled prostheses were withdrawn from the market in February 1992 but newer models are now again available (2001). The saline prosthesis (a plastic bag filled with salt water) is currently the only available method. The prosthesis is placed between the chest wall (ribs) and pectoral muscle through an incision in the inframammary region
- An alternative method of reconstruction is to use the patients own tissue to create a new breast mound. The most common is "TRAM Flap" (Transverse Rectus Abdominus Muscle). This involves moving tissue from one part of the body (the belly) to another (the chest wall). The surgeon creates a flap using the skin, fat and one of the abdominal muscles or muscles of the lower abdomen. This tissue is transferred from the abdomen to the breast area. Another type of "flap" reconstruction is the "latissimus dorsi flap" which involves moving tissue from the back to the chest wall. The surgeon transfers skin, muscle (the triangular muscle from the back), fat and the blood vessels that nourish them, from the back to the breast area
- Nipple reconstruction is usually done at a later date as a minor procedure, either after insertion of a saline prosthesis or a "flap reconstruction"
- A large breasted woman may require reduction of the opposite breast for symmetry
- The undressed appearance is not completely natural in the majority of cases
- Safety: Risks are the same as for other surgery:
- Anesthetic - .001%
- Infection - less than 1%
- Hemorrhage - 1% - 5%
Breast Implants (Prostheses)
Breast implants are not hazardous as long as the silicone is sealed in a bag or the prosthesis is the type that is inflated with saline (salt water). A survey of 31,000 women in California showed no increased risk of cancer. In rare instances if the silicone was injected directly into the breast tissue (not an implant) it could be cancer causing. This procedure has been occasionally done in the Orient.
Silicone Gel-Filled Implants (SGFI's) (August, 1992) Report on SGFI's by the Independent Advisory Committee on SGFI's is in file under "BREAST"
- Moratorium on use of SGFI's started January 8, 1992 and is still in place
- Enquiries from women who currently have implants should be referred to their physician or to Dr. Slaveka Vlahovick of Health and Welfare at (613) 954-0366
- Dow Corning and Bioplasty, two major manufacturers SGFI's are no longer manufacturing them
- In February 1992, the manufacturer of the silicone gel implants voluntarily withdrew the product from the market while further testing is undertaken. Women having problems with their prostheses should see their own doctor. If a woman has a gel-filled prosthesis that is not causing problems, there is no reason to have it removed.
MAMMOGRAMS AFTER BREAST IMPLANT
The technologist and doctor should be informed of the location of the implants so that X-rays can be taken from different angles to show as much of the breast tissue as possible. It is unlikely that any pressure from the X-ray machine would damage or rupture the silicone bag.
MRI: This test may be helpful in assessing the implant and may help diagnose tears or disruption of the implant.
Financial Assistance - Breast Prosthesis
Financial assistance toward the purchase of a permanent breast prosthesis is available through a variety of sources:
- Some private insurance extended benefit plans
- Pharmacare
- Ministry of Social Services and Housing
- Canadian Cancer Society's Breast Prosthesis Bank, BC & Yukon Division. Call 1-888-939-3333
Private Insurance
If you have extended benefits on your medical insurance plan, check to see what benefits your plan offers. If you are unsure, contact the "claims officer" for your medical plan and ask for details of your benefit package.
Prosthesis: Payment for breast prosthesis is limited to once every 24 months (2 years) per mastectomy, or a time limit consistent with the manufacturer's warranty, whichever is greater. Payment will be requested -- and will, knowingly, be provided -- only where replacement is indicated. Payment will not be requested merely as a consequence of satisfying a minimum of two years' wear for the product.
Pharmacare Regulations
Bras: Pharmacare will provide payment for up to two surgical bras on a once-only basis, within 6 months post mastectomy. This policy extends to any client previously fitted. Women over 65 years of age, who possess a Gold Care Card, will be automatically covered following the preceding guidelines, upon presentation of their Gold Card. No deductible is required.
PHARMACARE DEDUCTIBLE IS NOW $800.00. OVER THE $800.00, 70% OF THE BILLING IS REDEEMABLE. IF ON MEDICAL PREMIUM ASSISTANCE, OVER THE $600.00, 100% IS REDEEMABLE.
MINISTRY OF SOCIAL SERVICES AND HOUSING
B.C. residents who are assisted by the Ministry of Social Services and Housing and possess an H2 Care Card can receive total coverage of the previously listed mastectomy items. Consult with your social worker.
March 2007 We are currently reviewing and updating these pages. If you have any questions about your cancer and its treatment, please discuss with your oncologist or physician. Thank you.