Breast Cancer Reconstruction

A breast cancer diagnosis—or discovering you carry a gene that increases your risk—can be incredibly challenging. We are truly sorry you are facing this. Your primary focus should be on your cancer care, health, and overall well-being. Dr. Carpenter and our entire team at Vitruvian Surgical Institute are here to support you through this process. We aim to make your breast reconstruction options as straightforward and supportive as possible, allowing you to concentrate on healing and returning to your life, all while respecting your rights under the Women's Health and Cancer Rights Act. Our commitment includes providing information about plastic surgery for breast cancer to help you make informed decisions.

Personalized Treatment Plan

Every woman is unique, and Dr. Carpenter takes the time to develop personalized surgical plans tailored to your body and your goals. When considering breast reconstruction options after a diagnosis of breast cancer, the choices can seem endless and overwhelming. This page is designed to help prepare you for your discussion on plastic surgery for breast cancer and to provide an overview of your key options. Dr. Carpenter will explain your best options with you in further detail, ensuring you understand your rights under the women's health and cancer rights act.

Women’s Health and Cancer Rights Act

Your Rights Under the Women’s Health and Cancer Rights Act (WHCRA)In 1998, the Women’s Health and Cancer Rights Act (WHCRA) became federal law to protect patients who choose breast reconstruction after a mastectomy. If your health plan covers mastectomy, it must also cover:

All stages of reconstruction of the breast on which the mastectomy was performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Prostheses
Treatment of physical complications of the mastectomy, including lymphedema

These benefits apply to most group health plans and individual health insurance policies. Coverage can include standard deductibles and coinsurance that are consistent with the rest of your plan. Important things to know:

While WHCRA provides strong protections, some insurance plans may consider reconstruction after lumpectomy or other breast-preserving procedures as not medically necessary. In addition, payers sometimes limit the number of revision surgeries they will cover. We are happy to work with you and your insurance team to understand exactly what your plan covers and to advocate for the care you need and deserve.

Questions to Consider Before Reconstruction

What type of cancer operation are you having?

Will you have, or have you already had, radiation?

Radiation plays a crucial role in the decision-making process for breast reconstruction options, as it can influence both the final aesthetic outcome and the timing of reconstruction. We consider this factor when determining the best technique and schedule for you, particularly in the context of plastic surgery for breast cancer and the implications of the women's health and cancer rights act.

Your Reconstruction Options

No Reconstruction (“Go Flat”)

Implant-Based Reconstruction

Tissue Expanders vs. Direct-to-Implant Reconstruction

Implant-based breast reconstruction options can occur in either one or two stages: direct-to-implant (single stage) or tissue expander reconstruction (two stage).

Direct-to-Implant means the final implant is placed at the same time as the mastectomy in a single stage. This approach is most common for prophylactic (preventive) mastectomies in women with youthful, non-ptotic breasts. If you have larger breasts and are considering a nipple-sparing direct-to-implant method, Dr. Carpenter can first perform a staged breast reduction/lift to position the nipple and skin perfectly before the mastectomy.

Tissue expanders are typically the more common starting point for most mastectomy patients undergoing plastic surgery for breast cancer. A temporary expander is placed at the time of mastectomy and gradually filled with saline over weeks to months. This allows the skin to stretch gently before the final implant is placed, aligning with the principles outlined in the Women's Health and Cancer Rights Act.

Autologous (Your Own Tissue) Reconstruction

"Autologous" refers to the use of your own living tissue for breast reconstruction options, allowing for the creation of a breast entirely from your own body or the addition of healthy tissue when skin has been compromised by radiation. Common donor sites for this plastic surgery for breast cancer include the abdomen or back.

DIEP Free Flap: This technique utilizes skin and fat from the lower abdomen while preserving the abdominal muscle. The blood vessels are meticulously reconnected under a microscope, a process known as microsurgery.
TRAM Free Flap: This method is similar to the DIEP flap but incorporates a small portion of abdominal muscle.
TRAM Pedicled Flap: This approach uses abdominal skin, fat, and muscle while remaining attached to its original blood supply, which is tunneled to the chest.
Latissimus Pedicled Flap: This technique employs skin, fat, and muscle from the upper back, which is tunneled to the chest. It is often combined with an implant for added volume.

Note from Dr. Carpenter: In our practice, I perform both pedicled latissimus and pedicled TRAM flaps. For women who are ideal candidates for a DIEP flap, I will refer you to a specialized academic center or a local microsurgery fellowship-trained plastic surgeon. If your breast surgeon is at Coral Springs Medical Center, I can place a tissue expander at the time of your mastectomy. Once chemotherapy and radiation are complete, I will seamlessly connect you with the right DIEP team to ensure you receive the best care under the women's health and cancer rights act.

Mixed Implant + Autologous Reconstruction

Some women benefit from combining their own tissue (often a latissimus flap) with a small implant as part of their breast reconstruction options. This approach adds natural padding and volume while still using the implant for projection and shape, offering a tailored solution in plastic surgery for breast cancer. It's important to be aware of the women's health and cancer rights act to ensure all options are considered.

Adjuncts to Breast Reconstruction

After your initial breast reconstruction, we can refine results with additional procedures that enhance your overall outcome. Among the breast reconstruction options available, nipple reconstruction uses local skin to create a three-dimensional nipple projection—similar to a small origami fold. Many women feel more “complete” after this important step. Additionally, nipple tattooing can be performed to add natural color to the areola. This can be done with or without surgical nipple reconstruction and can be performed by Dr. Carpenter or a specialized medical tattoo artist. Another option is fat grafting, where liposuction from the abdomen, flanks, or thighs harvests your own fat cells, which are then carefully injected into the reconstructed breast. This process fills contour irregularities, softens the look of implants, and creates a more natural feel and appearance. If you have undergone plastic surgery for breast cancer, matching procedures on the opposite breast, such as a lift (mastopexy), reduction, or small implant on the natural breast, can create beautiful symmetry. Remember, your choices are supported under the women’s health and cancer rights act, ensuring you have access to the care you deserve.

Your Most Typical Journey with Dr. Carpenter

What to expect

For the majority of women having mastectomy and implant-based reconstruction, the path looks like this:

At the time of mastectomy: Tissue expander placement (pre-pectoral or sub-pectoral) plus acellular dermal matrix (ADM) to reinforce the pocket and support the implant.
Healing (about 4 weeks): Let the skin settle.
Expansion phase (6–12 weeks): Office visits every 1–2 weeks where we add 50 cc of fluid at a time. Some tenderness is normal, especially with sub-pectoral placement.
Tissue expander to permanent implant exchange: We wait at least 3–6 months (longer if you need chemotherapy or radiation) so your body forms a stable capsule and tissues are fully healed. At this exchange, Dr. Carpenter also performs fat grafting for the softest, most natural result.
Nipple reconstruction and tattooing: Once the breast mound is complete, radiation is finished, and everything has settled, we create the nipple and add areolar color.
Lifelong care: Your reconstructed breast(s) will continue to evolve. One natural breast and one reconstructed breast age differently, and radiation can cause additional changes. You may need occasional revisions for firmness (capsular contracture), implant rupture, or to maintain symmetry. We are here for you long after the initial reconstruction is complete.

Helpful Resources for More Information

We encourage you to explore these trusted national resources:

American Society of Plastic Surgeons – Breast Reconstruction: https://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction
National Cancer Institute – Breast Reconstruction After Mastectomy: https://www.cancer.gov/types/breast/treatment/surgery/breast-reconstruction
Centers for Medicare & Medicaid Services – Women’s Health and Cancer Rights Act: https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/whcra_factsheet

Dr. Carpenter and our team are always available to answer your questions in person. Please call us at 954-344-4344 to schedule a consultation. You are not alone in this—we are here to support you every step of the way.

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