Q. I’m having a mastectomy, and after hearing about the various choices I have for reconstruction, I’ve decided to have an implant. Now I have to make the decision whether to have the implant done right away, or wait till later. Help, I’m stuck!
A. One-stage (immediate) reconstruction with an implant is done at the same time you have your mastectomy; two-stage (delayed) is done at some point in the future, after the mastectomy scar has healed. Here are some advantages and disadvantages of each:
One-stage (immediate) reconstruction means only one surgery, which means lower cost, less time spent under anesthesia, and less time spent recovering. It also means a slightly longer recovery time (than from a straight mastectomy), and more chance of an infection, which could delay your cancer treatment.
The main advantage of two-stage (delayed) reconstruction is that it gives you time to consider your choices: of surgeon, dates, and type of implant. Right now, your mind may be so filled with cancer worries that you don’t want to make yet another decision; for you, a delayed reconstruction may be the answer.
However, delayed reconstruction also involves two surgeries, which means greater cost, more time spent under anesthesia, and a longer amount of time spent recovering. It also might mean your insurance won’t cover it; some insurance companies cover only one post-mastectomy treatment, so if you purchase a breast form and claim it on insurance while you’re waiting for implant surgery, they may refuse to cover the subsequent implant surgery.
If you feel calm and strong and reasonably certain about the path you’re taking, immediate reconstruction is probably for you. If you have serious doubts about any of it–the surgery itself, the surgeon, what type of implant to choose–you may want to take more time making this important decision, and have reconstruction done later down the road.
Q. I also have to decide on silicone vs. saline. I’d heard silicone gives a better result, but wasn’t it banned or something? What’s up with that?
A. After 20 years of usage, silicone implants were banned by the F.D.A. in 1992 as being unsafe. One study found that as many as 69% of women with implants experienced ruptures, resulting in the implants becoming hard and painful. Some claimed leaking silicone traveled through their bodies, causing cancer and autoimmune disorders, such as rheumatoid arthritis.
A class-action suit by women against several implant manufacturers resulted in settlements in the women’s favor, and triggered the withdrawal of the implants from the market. Despite the legal settlement, however, there’s no reliable research showing that implants – silicone, or saline – cause immune system disease, or increase cancer risk. And this year, the F.D.A. lifted the ban, claiming silicone implants, while they may still rupture and be painful, are basically safe.