Practical issues

Financial issues

Funding by public health care systems or by private insurance companies can vary enormously and depends mainly on local policy.

For example, in Switzerland and the United States, private insurance companies will only agree to reimburse procedures if prior approval is obtained. Your plastic surgeon needs to submit this request for reimbursement.

However, in many countries breast reconstruction is a legal entitlement and insurance companies need a strong argument to refuse to pay. However, if a very low fee is offered, it may not be financially viable for hospitals to perform this surgery.

In countries with public health care systems like Belgium, France, Ireland, Italy and the United Kingdom prior approval is not always necessary. Unfortunately though, hospital reimbursement remains low. This can make it difficult to find a large number of centers that offer all the options for breast reconstruction. There is also a temptation for hospitals to provide only the most lucrative techniques, instead of the most appropriate procedure for the patient.

Therefore, in some countries additional fees may be charged to supplement the fees provided by the public health care system. This insures that all patients are offered the most appropriate reconstructive technique. These extra funds can be provided by your own additional private insurance or may need to be self-funded.

We suggest that you talk to your surgeon or the office staff about the financial implications of your surgery. Also read your insurance policy carefully and make sure that you fully understand your level of cover.

Absence from work

The total amount of time that you are off work is determined by the ablative surgery required, your reconstructive technique and the need for adjuvant therapy.

 

1. Patients undergoing immediate reconstruction

(a) After breast conserving surgery

Remodeling or loco-regional flaps do not add to the time off work. After a healing period of 3 – 4 weeks, radiotherapy is required for the next 5 – 6 weeks.

A few additional weeks recovery may be needed after the adjuvant treatment.

(b) For a partial or total mastectomy

Without reconstruction or adjuvant therapy, the recovery period is around 3 – 4 weeks.

If an immediate reconstruction is performed, the total time off will be about 6 weeks.

If additional adjuvant therapy is required (chemotherapy or radiotherapy), the total recovery time is more substantial.

Radiotherapy generally adds 5 to 8 weeks while chemotherapy may add 6 months.

2. Patients undergoing delayed reconstruction

For both implant based and autologous reconstruction, a 6 week recovery period is necessary.

Returning to full daily activities is much easier following perforator flap breast reconstruction because muscle function and strength are preserved.

 

Surgeon

In immediate breast reconstruction, the surgery is performed by two teams, often from different specialties. The removal of the tumour, the breast gland and/or axillary node(s) is done by a surgical oncologist. This can be a general surgeon, gynaecologist or plastic surgeon. Simultaneously or immediately afterwards, plastic surgeons perform the reconstruction using either an implant or autologous (own body) tissue.

In delayed breast reconstruction, two teams of plastic surgeons are involved. One group prepares the recipient site by opening the existing scar, creating a pocket to contain the new breast and dissecting the internal mammary vessels. At the same time, the second team harvests the flap. After transferring the tissue and performing the microsurgical anastomosis, both teams then help to close the remaining wounds. In implant based reconstruction, only one team of plastic surgeons is required.

Plastic surgeons are specialized physicians who, after completing a medical degree, undergo intensive training in both general (3-6 years) and plastic surgery (3-5 years). They specifically perform complex reconstructive procedures and are equipped to deal with any possible complications. Not all plastic surgeons have experience in breast reconstruction and it is wise to check beforehand. It is also important that you identify who will be responsible for your surgery and post-operative care.