Breast Reconstruction After Lumpectomy

The amount of breast tissue that surgeons remove during a lumpectomy can vary widely, depending on the size of the breast tumor. For some people, a lumpectomy will lead to minor changes in the appearance of the affected breast. Others may have more noticeable changes, such as dents, dimpling, or significant changes in the shape or size of the breast. This is especially the case if a larger area of tissue needs to be removed or it’s a large area relative to the size of the breast. 

Most people who get a lumpectomy receive radiation therapy afterwards. Radiation treatments can cause additional changes in the appearance of the affected breast — for example, the breast may become smaller and the texture of the skin may change. 

Before having a lumpectomy, you may want to ask your surgeon about the amount of breast tissue that’ll be removed during the surgery and how the surgery and radiation treatments might affect your breast’s appearance. This information can help you decide if you’d like to have breast reconstruction. 

Reconstruction during or after a lumpectomy is usually done by a plastic surgeon (not by the breast surgeon who removes the cancer). If you’re considering reconstruction or not sure, it may be helpful to meet with one or more board-certified plastic surgeons who specialize in breast reconstruction to discuss your options. 

You might have choices about when the reconstruction is performed. Some people are candidates for having reconstruction during the same surgery in which the cancer is removed (the lumpectomy); others might be advised to — or might choose to — have it months or years later. The timing will depend on factors such as the type of reconstruction you choose, whether you’re having radiation therapy, and whether you have any medical conditions that increase the risk of wound healing problems. In some cases, your surgical team may recommend that you wait for a period of months or for a year after completing radiation therapy before getting reconstruction.   

There’s no standard approach to reconstruction after lumpectomy. Your surgical team can offer advice on your options and the timing of reconstruction. Your options might include getting one or more of the following procedures:

Oncoplastic surgery is usually done by a plastic surgeon during the same surgery in which the cancer is removed (the lumpectomy). The procedure can involve: 

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  rearranging breast tissue to fill in indentations 

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  performing a breast reduction or lift on the affected and healthy breasts to make them more symmetrical 

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  relocating nipples to make them more symmetrical

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  preventing and reducing scarring

If you want to have immediate oncoplastic surgery (that takes place at the same time as the lumpectomy), you’ll need to either find a plastic surgeon who can work as a team with your breast surgeon, or a breast surgeon who is experienced in oncoplastic techniques. 

In some cases, oncoplastic surgery can take place months or years after a lumpectomy.  

These procedures are usually done at least six months to a year after the lumpectomy surgery and radiation treatments. Waiting gives your body time to heal. And if there are any changes from the lumpectomy and radiation that you decide you want to address, it gives them time to settle into place.      

Fat grafting (also called fat injections, fat transfer, or lipofilling) involves removing fat tissue from another part of the body, such as your thighs or belly, by liposuction. Then the tissue is processed into liquid and injected into the breast area. Fat grafting treatments can add volume to the breast, fill in dents or divots, and minimize the appearance of scars.  

A breast implant is a round, flexible silicone shell filled with either saline (salt water) or silicone gel. Implants can be used to maintain the shape and appearance of one or both breasts. 

Flaps of tissue from your belly, buttocks, back, or thighs can be used to form a breast shape and  improve the symmetry between your affected and healthy breast. Skin, fat, and sometimes muscle are used to form the breast shape.  

Also, various types of corrective (or “revision”) procedures can be performed if you developed a complication after an earlier breast reconstruction surgery. 

In the U.S., reconstruction procedures after lumpectomy are covered by most, but not all, health insurance plans. A federal law called the Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires all group health plans and health insurance companies (including HMOs) that pay for mastectomy to also cover all stages of breast reconstruction. Many states have passed additional laws requiring insurance companies to cover breast reconstruction. In addition, Medicare covers breast reconstruction; Medicaid coverage can vary from state to state.

Read more tips about navigating insurance and payment for breast reconstruction.

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