Breast reconstruction is a surgical procedure to restore the appearance of a breast for women who have had a breast removed (mastectomy) to treat breast cancer. The surgery rebuilds the breast so that it is about the same size and shape as it was before it was removed. The nipple and areola (the darker area surrounding the nipple) can also be added. Most women who have had a mastectomy can have reconstruction. Women who have had a lumpectomy usually do not need reconstruction. Breast reconstruction is done by a plastic surgeon.

This information is designed to give you the facts you need to make an informed decision about breast reconstruction. It will help you better understand the process and the words used when talking about breast reconstruction. The words in italics are further explained in the glossary at the end of this information.

The decision to have breast reconstruction is a matter of personal choice. Learn as much as you can about the process before making a decision. No single source of information can provide every fact or give you all the answers. You and those close to you should discuss any questions and concerns about reconstructive surgery with your health care team.

Each year more than 240,000 American women face the reality of breast cancer. Today, the emotional and physical results are very different from what they were in the past. Great strides have been made in our understanding of this disease and its treatment. New approaches in treatment, as well as advances in reconstructive surgery mean that women who have breast cancer today have new and better choices.

More and more women with breast cancer are choosing surgery that removes less breast tissue than a mastectomy (removal of the entire breast). This is called breast conservation surgery (or lumpectomy or segmental mastectomy). However, some women choose (or need) a mastectomy. Some of those who have a mastectomy also choose to have reconstructive surgery to restore the breast's appearance.

If you are thinking about having reconstructive surgery, it is a good idea to discuss it with your surgeon and a plastic surgeon experienced in breast reconstruction before your mastectomy. This allows the surgical teams to plan the treatment that is best for you, even if you decide to wait and have reconstructive surgery later.

Women choose breast reconstruction for different reasons. The goals of reconstruction are:

• to make your breasts look balanced when you are wearing a bra 
• to permanently regain your breast contour 
• to give the convenience of not needing an external prosthesis

The difference between the reconstructed breast and the remaining breast can be seen when you are nude. When the breasts are in a bra though, they should be close enough to one another in size and shape that you will feel comfortable about how you look in most types of clothing.

Your body image and self-esteem may improve after your reconstruction surgery, but this is not always the case. Breast reconstruction does not fix things you were unhappy about before your surgery. Also, you may be disappointed with how your breast looks after surgery. You and those close to you must be realistic about what to expect from reconstruction.

You should decide to have breast reconstruction only after you are fully informed about the procedure. There are often many options to think about as you and your doctors discuss what is best for you. The reconstruction process may require one or more operations. You should talk about the benefits and risks of reconstruction with your doctors before the surgery is planned. Give yourself plenty of time to make the best decision for you.

Immediate or Delayed Reconstruction with Breast Cancer

Immediate reconstruction is done at the same time as the mastectomy. A plus with immediate reconstruction is that the chest tissues are undamaged by radiation therapy or scarring. Also, immediate reconstruction means one less surgery.

Delayed reconstruction is done at a later time. For some women, this may be advised if radiation to the chest area is needed after the mastectomy. This is because radiation therapy that follows breast reconstruction can increase complications after surgery.

Decisions about reconstructive surgery depend on many personal factors such as:

• your overall health 
• the stage of your breast cancer 
• the size of your natural breast 
• the amount of tissue available (for example, very thin women may not have enough extra body tissue to make flap grafts possible) 
• your desire to match the appearance of the opposite breast 
• your desire for bilateral reconstructive surgery and your insurance coverage for the unaffected breast and related costs 
• the type of procedure 
• the size of implant or reconstructed breast

Other important factors to consider:

• You may not want to think about this issue while you are coping with a diagnosis of cancer. If this is the case, you may choose to wait until after your breast cancer surgery to decide about reconstruction. 
• You may simply not want to have any more surgery than is needed. 
• Scarring is a natural outcome of any surgery, but skin necrosis (cell death) may occur if your ability to heal is impaired. 
• Not all surgery is completely successful, and you may not be pleased with your cosmetic result. 
• You may be concerned if you have bleeding or scarring tendencies. 
• Your ability to heal may be hindered by previous surgery, chemotherapy, radiation, smoking, alcohol, diabetes, various medicines, and other factors. 
• Is it your preference to have chemotherapy or radiation therapy after reconstruction or wait and have surgery after all treatment is completed? 
• Breast reconstruction restores the shape of the breasts but cannot restore your normal breast sensation. With time, the skin on the reconstructed breast can become more sensitive, but it will not give you the same kind of pleasure as before a mastectomy. 
• Surgeons may suggest you wait for one reason or another. This may happen if you smoke or have other health conditions. Many surgeons require you to quit smoking at least 2 months before reconstructive surgery to allow for better healing. You may not be able to have reconstruction at all if you are obese, too thin, or have circulatory problems. 
• The surgeon may recommend surgery to reshape the remaining breast to match the reconstructed breast. This could include reducing or enlarging the size of the breast or lifting the breast. 
• Knowing your reconstruction options before surgery can help you prepare for a mastectomy with a more realistic outlook for the future.

Types of Breast Reconstruction

One-stage immediate breast reconstruction may be done at the same time as your mastectomy. After the general surgeon removes the breast tissue, a plastic surgeon places a breast implant where the breast tissue was removed to form the breast contour.

Two-stage immediate or two-stage delayed reconstruction is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander, like a balloon, is placed beneath the skin and chest muscle. Through a tiny valve beneath the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over time. After the skin over the breast area has stretched enough, the expander is usually removed in a second operation, and a permanent implant is put in its place. Some expanders are left in place as the final implant.

There are some important factors for you to think about when deciding to have implants:

• Your implants may not last a lifetime, so you may need more surgery to replace them. 
• You can have local complications with breast implants such as rupture, pain, capsular contracture (scar tissue forms around the implant), infection, or an unpleasing cosmetic result. This means that implants may become less attractive over time.

Tissue Flap Procedures

Tissue flap procedures use tissue from your tummy, back, thighs, or buttocks to reconstruct the breast. The 2 most common types of tissue flap surgeries are the TRAM flap (transverse rectus abdominis muscle flap), which uses tissue from the tummy area, and the latissimus dorsi flap, which uses tissue from the upper back. These operations leave 2 surgical sites and scars, both from where the tissue was taken and on the reconstructed breast. The scars fade over time, but they will never go away completely. There can also be complications at the donor sites, such as abdominal hernias and muscle damage or weakness. There can also be differences in the size and shape of the 2 breasts. Because blood vessels are involved, these procedures usually cannot be offered to women with diabetes, connective tissue or vascular disease, or to smokers.

TRAM (transverse rectus abdominis muscle) Flap

The TRAM flap procedure uses tissue and muscle from the lower abdominal wall (tummy tissue). The tissue from this area alone is often enough to create a breast shape, and an implant may not be needed. The skin, fat, blood vessels, and at least 1 of the abdominal muscles are moved from the abdomen to the chest area. This procedure also results in a tightening of the lower abdomen, or a "tummy tuck." There are 2 types of TRAM flaps:

• Pedicle flap involves leaving the flap attached to its original blood supply and tunneling it under the skin to the breast area. 
• Free flap means that the surgeon cuts the flap of skin, fat, blood vessels, and muscle free from its original location and then attaches the flap to blood vessels in the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels and takes longer to finish than a pedicle flap. The free flap is not done as often as the pedicle flap but some doctors think that it can result in a more natural shape.

Latissimus Dorsi Flap

The latissimus dorsi procedure moves muscle and skin from your upper back when extra tissue is needed. The flap is made up of skin, fat, muscle, and blood vessels. It is tunneled under the skin to the front of the chest. This creates a pocket for an implant, which can be used for added fullness to the reconstructed breast. Though it is not common, some women may have weakness in their back, shoulder, or arm after this surgery.



DIEP (deep inferior epigastric artery perforator) Flap

A newer type of flap procedure, the DIEP flap, uses fat and skin from the same area as in the TRAM flap but does not use the muscle to form the breast mound. This procedure results in a tightening of the lower abdomen, or a "tummy tuck." The procedure is done as a "free" flap meaning that the tissue is completely detached from the tummy and then moved to the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels. The procedure takes longer than the TRAM pedicle flap discussed above.

Donor Site	DIEP Flap

Gluteal Free Flap

This is another newer type of surgery that uses tissue, including the gluteal muscle, from the buttocks to create the breast shape. It is an option for women who cannot use the tummy sites due to thinness, incisions, failed tummy flap, or patient preference. The procedure is similar to the free TRAM flap mentioned above. The skin, fat, blood vessels, and muscle are detached from the buttock and then moved to the chest area. This requires the use of a microscope (microsurgery) to connect the tiny vessels.

The decision to have your nipple and areola (the dark area around the nipple) reconstructed is up to you. Nipple and areola reconstructions are optional and considered the final phase of breast reconstruction. This separate surgery is done to make the reconstructed breast more closely resemble the original breast. It can be done as an outpatient under local anesthesia. It is usually done after the new breast has had time to heal (usually 3-4 months after surgery).

The ideal nipple and areola reconstruction requires symmetry in position, size, shape, texture, color, and projection. Tissue used to rebuild the nipple and areola is taken from your own body, such as from the newly created breast, opposite nipple, ear, eyelid, groin, upper inner thigh, or buttocks. Tattooing may be done to match the color of the nipple of the other breast and to create the areola.

Although it is done, saving and using the nipple from the breast with cancer that has been removed (called nipple saving or nipple banking) is not a good idea. Cancer cells may still be hidden in the nipple and the tissue is often injured by the cryopreservation process necessary for storage. Further research is needed in this area.

To find out if a surgeon is board certified, contact the American Society of Plastic Surgeons (ASPS). This organization has a Plastic Surgery Information Service that provides a list of ASPS members in a caller's area who are certified by the American Board of Plastic Surgery. ASPS contact information is provided in the "Additional Resources" section toward the end of this document.

Questions to Ask

It is very important that you ask as many questions of your surgeon as you need to before having breast reconstruction. If you don't understand something, ask your surgeon about it. Here is a list of questions to get you started. Write down other questions as you think of them. You may want to record your conversations with your surgeons. It is also helpful to bring a friend or family member with you to the doctor to help you remember what was said. The answers to these questions may help you make your decisions.
 

• Am I a candidate for breast reconstruction?
• When can I have reconstruction done?
• What types of reconstruction are possible in my specific case?
• What is the average cost of each type? Does my insurance cover them?
• What type of reconstruction is best for me? Why?
• How much experience do you (plastic surgeon) have with this procedure?
• What results are realistic for me?
• Will the reconstructed breast match my remaining breast in size?
• How will my reconstructed breast feel to the touch?
• Will I have any feeling in my reconstructed breast?
• What possible complications should I know about?
• How much discomfort or pain will I feel?
• How long will I be in the hospital?
• Will I need blood transfusions? If so, can I donate my own blood?
• How long is the recovery time?
• What type of wound care will I need to do at home?
• How much help will I need at home to take care of my drain and wound?
• When can I start my exercises?
• How much activity can I do at home?
• What do I do if I get swelling (lymphedema) in my arm?
• When will I be able to return to normal activity such as driving and working?
• Can I talk with other women who have had the same surgery?
• Will reconstruction interfere with chemotherapy?
• Will reconstruction interfere with radiation therapy?
• How long will the implant last?
• What kinds of changes to the breast can I expect over time?
• How will aging affect the reconstructed breast?
• What happens if I gain or lose weight?
• Are there any new reconstruction options that I should know about?

After reviewing your medical history and overall health, your surgeon will explain which reconstructive options are best for your age, health, body type, lifestyle, and goals. Openly discuss your expectations. Your surgeon should be frank with you when talking about your risks and benefits for each option.

Breast reconstruction after a mastectomy can improve your appearance and renew your self-confidence. However, keep in mind that the desired result is improvement, not perfection.

If you would like to talk with someone who has had your type of surgery, our Reach to Recovery volunteers are trained to support people facing breast cancer, as well as those who have surgery, chemotherapy, radiation therapy, and who are thinking about breast reconstruction. Ask your doctor or nurse to refer you to a Reach to Recovery volunteer in your area, or call us at 1-800-ACS-2345.

Your surgeon should also explain the details of your surgery, including:

• the anesthesia he or she will use 
• where the surgery will take place 
• what to expect after surgery 
• the plan for follow-up 
• costs

Health insurance policies often cover most or all of the cost of reconstruction after a mastectomy. Check your policy to make sure you are covered. Also, see if there are any limits on what types of reconstruction are covered.

Be aware that some insurance companies will deny breast reconstruction costs if you have already submitted claims for a breast prosthesis.

Preparing for Your Surgery

Your breast surgeon and your plastic surgeon will give you specific instructions on how to prepare for surgery. These will likely include:

• guidelines on eating and drinking 
• tips to quit smoking 
• instructions to take or avoid certain vitamins and medicines for a period of time before your surgery

You should arrange for someone to drive you home after your surgery and to help you out for a few days.

Where Your Surgery Will Be Performed

Breast reconstruction often involves more than 1 operation. The first stage involves creation of the breast mound. Whether this is done at the same time as the mastectomy or later on, it is usually done in a hospital.

Follow-up procedures, such as creating the nipple and areola, may also be done in the hospital or in an outpatient facility. This decision depends on the extent of surgery needed and what your surgeon prefers.

Types of Anesthesia

The first stage of reconstruction is almost always done using general anesthesia, so you'll be asleep during the surgery.

Follow-up procedures may only require a local anesthesia to make the area numb with a sedative to make you drowsy. You'll be relaxed but awake, and you may feel some discomfort.

Possible Risks

Almost any woman who must have her breast removed because of cancer can have reconstructive surgery. Certain risks go along with any surgery, and reconstruction may have certain unique problems associated with it.

Some risks of reconstruction surgery are:

• bleeding 
• fluid collection with swelling and pain 
• excessive scar tissue 
• infection 
• tissue necrosis (death) of all or part of the flap 
• problems at the donor site (immediate and long-term) 
• changes in nipple and breast sensation 
• fatigue 
• the need for additional surgeries to correct problems 
• changes in the affected arm 
• problems with anesthesia

Risks of smoking

The use of tobacco causes constriction of the blood vessels and reduces the supply of nutrients and oxygen to tissues. As with any surgery, smoking can delay healing. This can result in scars that are more noticeable and a longer recovery time. Sometimes these complications are severe enough to require a second operation. You may be asked to quit smoking before surgery.

Risks of infection

Infection can develop with any surgery. This usually happens within the first 2 weeks after surgery. If an implant has been used, it may need to be removed until the infection clears. A new implant can be inserted later. If you have a tissue flap, surgical cleaning of the wound is usually done.

Risks of capsular contracture

The most common problem with breast implants is capsular contracture. This happens when the scar or capsule around the implant begins to tighten and squeezes down on the soft implant. It can make the breast feel very hard. Capsular contracture can be treated in several ways. Sometimes more surgery is needed to remove the scar tissue. The implant might also need to be removed or replaced.

After Breast Reconstruction Surgery

What to Expect

You are likely to feel tired and sore for a week or 2 after implant reconstruction and longer after flap procedures. Your doctor can give you medicines to control most of your discomfort.

Depending on the type of surgery, you should go home from the hospital in 1 to 6 days. You may be discharged with a surgical drain in place. The drain is needed to remove excess fluids from the site while it heals. Follow your doctor’s exact instructions on wound and drain care. If you have any concerns or questions, call your doctor.

Getting Back to Normal

You should be up and around in 6 to 8 weeks. If implants are used without flaps, your recovery time may be less. Some things to remember:

• Reconstruction does not restore normal sensation to your breast, but some feeling may return. 
• It may take as long as 1 to 2 years for tissues to completely heal and for scars to fade, but the scars never go away entirely. 
• Follow your surgeon's advice on when to begin stretching exercises and normal activities. As a rule, you'll want to avoid any overhead lifting, strenuous sports, and sexual activity for 4 to 6 weeks following reconstruction. 
• Women who have reconstruction months or years after a mastectomy may go through a period of emotional readjustment once they have their breast reconstructed. Just as it takes time to get used to the loss of a breast, you may feel anxious and confused as you begin to think of the reconstructed breast as your own. Talking with other women who have had reconstruction might be useful. Talking with a mental health professional may also help with these feelings. 
• Silicone gel implants may open up inside the body without causing symptoms. Women with this type of implant should have MRI scans of the breast starting 3 years after surgery and every 2 years after that to detect this problem. If the silicone device ruptures, another surgery will be required to replace it.

For more information on coping after cancer, see After Diagnosis: A Guide for Patients and Families and Sexuality for the Woman Who Has Cancer and her Partner. You can have these documents sent to you by calling 1-800-ACS-2345.

Breast Reconstruction and Cancer Recurrence

Studies to date have shown that reconstruction has no known effect on the recurrence of breast cancer. It should not cause problems with chemotherapy or radiation treatment if cancer does recur.

If you are considering breast reconstruction, either with an implant or flap, you need to know that reconstruction rarely, if ever, hides a return of breast cancer. You should not consider this a significant risk when deciding to have breast reconstruction after mastectomy.

Talk to your doctors about mammograms.

It is important to have regularly scheduled mammograms on the opposite breast at a facility with technologists experienced in taking and reading mammograms. All doctors may not recommend mammograms for a breast reconstructed with an implant. Mammogram pictures can be impaired by implants; more so by silicone than saline filled. If you need a mammogram and your reconstruction involves an implant, be sure to get your mammograms done at an accredited facility with technologists trained in manipulating the implant to get the best possible images of the rest of the breast.

While studies have supported mammograms of tissue flap breast reconstructions, no standard recommendation is in place. It is recognized that reconstructed breasts can have a fatty appearance, surgical clips, and surgical scars visible on the mammogram, but abnormalities can also be seen. Cancer can come back in the skin or any remaining breast tissue at areas of breast reconstruction. If you have a tissue flap reconstruction, you may need to continue mammograms on both breasts. Discuss this with your plastic surgeon and oncologist.

Breast Self-Examinations

After breast reconstruction, you may choose to keep doing breast self-examination (BSE). Check both the remaining breast and the reconstructed breast at the same time. This will help you learn what is normal for you so that you can find any changes in the future. The reconstructed breast will feel different, and the remaining breast may change, too. Your doctor or nurse can help you understand what is normal so that you can notice and report any changes as quickly as possible. To learn how to do breast self-examination after mastectomy, ask your doctor or nurse, call us at 1-800-ACS-2345, or see our document,Breast Cancer: Early Detection.

Our Reach to Recovery Program

Reach to Recovery is an American Cancer Society volunteer visitation program. Breast cancer survivors are trained to respond to you and your family’s concerns when facing the diagnosis, treatment, and effects of breast cancer.

In many locations, trained Reach to Recovery volunteer visitors who have had breast reconstruction are available to visit with you if you are thinking about this type of surgery. These visits are always free of charge.

To request a Reach to Recovery visit ask your doctor or nurse for a referral, contact us at 1-800-ACS-2345, or use the "Contact Us" button at www.cancer.org.

Glossary

Alternative breast implants: implants that have different exterior shells and are filled with different materials. These are still being studied in clinical trials.

Anesthesia: the loss of feeling or sensation caused by drugs or gases. General anesthesia causes loss of consciousness ("puts you to sleep"). Local or regional anesthesia numbs only a certain area.

Areola: the darker area surrounding the nipple

Breast conservation surgery: surgery to remove a breast cancer and a small area of normal tissue around the cancer without removing any other part of the breast. The lymph nodes under the arm may be removed, and radiation therapy is often given after the surgery. This method is also called lumpectomy, segmental excision, limited breast surgery, or partial or segmental mastectomy.

Breast implant: a sac used to increase breast size or restore the contour of a breast after mastectomy. The sac is filled with sterile saltwater (saline) or silicone gel.

Breast reconstruction: surgery that rebuilds the breast contour or shape after mastectomy. A breast implant or the woman's own tissue is used. If desired, the nipple and areola may also be recreated. Reconstruction can be done at the time of mastectomy or any time later.

Capsular contracture: scar tissue formation around the implant that tightens and squeezes the implant. There are 4 grades of contracture (Grades I-IV) that range from normal and soft to hard, painful, and distorted.

Clinical trials: studies of new treatments in patients. They are only done when there is reason to believe that the treatment being studied may be of value to patients.

Delayed reconstruction: reconstructive surgery that is done at a later time, not at the time of the original mastectomy surgery

DIEP (deep inferior epigastric artery perforator) flap: a type of flap procedure that uses fat and skin from the same area as in the TRAM flap, but does not use the muscle to form the breast mound

Free flap: in this kind of surgery the tissue for reconstruction is moved entirely from another area of the body and the blood and nerve supplies are surgically reattached with special microscopes

Gluteal free flap: a newer type of flap procedure that uses tissue and gluteal muscle from the buttocks to create the breast shape

Immediate breast reconstruction (also called one-stage reconstruction): reconstructive surgery that is done at the same time as the mastectomy, when the entire breast is removed

Latissimus dorsi flap: this procedure tunnels muscle, fat, and skin from the upper back to the chest to create a breast mound

Lumpectomy: surgery that removes only the breast lump and a margin of normal tissue around it

Mastectomy: surgical removal of the part or all of the breast, and sometimes other tissue. See also segmental mastectomy

Microsurgery or microvascular surgery: procedure that uses microscopes and fine surgical instruments to reattach the blood and nerve supply to tissues that have been removed from another area

Necrosis: cell and tissue death from lack of blood supply to the tissue

Pedicle flap: tissue that is surgically removed but the blood vessels remain attached and are tunneled from the original site to the area the tissue is to be attached

Saline-filled implant: has an external silicone shell and is filled with sterile saline (salt water)

Segmental mastectomy: surgery that removes more breast tissue than a lumpectomy (up to one-quarter of the breast). Also called partial mastectomy or quadrantectomy

Silicone gel-filled implants: breast implants filled with a synthetic material. Because of its flexibility, strength, and texture, it is similar to the natural breast. Silicone gel breast implants are now available for women who have had breast cancer surgery but additional follow-up is required to watch for possible rupture of the implant.

Tissue expander: implanted, inflatable balloons under the skin are used to keep living tissues under tension. This causes new cells to form and the amount of tissue to increase. The surgeon inserts the balloon expander beneath the skin where the breast should be and periodically, over weeks or months, injects a saline solution to slowly expand the overlaying skin to create space for an implant.

Tissue flap reconstruction: tissue for reconstruction that is surgically removed from another area of the body. It can be a pedicle (attached and tunneled) or free flap (unattached).

Transverse rectus abdominis muscle (TRAM) flap: a procedure that uses tissue and muscle from the lower tummy wall to reconstruct a breast mound. It can be a pedicle (attached and then tunneled) or free flap (unattached).

Two-stage reconstruction: a two-step procedure that is done if your skin and chest wall tissues are tight and flat. An implanted tissue expander is placed beneath the skin and chest muscle. It is like a balloon that is inflated with saline over time and an implant is surgically placed when the desired fullness of the expander is achieved.

More Information from Your American Cancer Society

We have selected some related information that may also be helpful to you. These materials may be ordered from our toll-free number, 1-800-ACS-2345.

• After Diagnosis: A Guide for Patients and Families

• Breast Cancer

• Breast Cancer: Early Detection

• Breast Prostheses List

• Reach To Recovery

• Sexuality For Women and Their Partners

National Organizations and Web Sites*

In addition to the American Cancer Society, other sources of patient information and support include:

American Society of Plastic Surgeons (ASPS)
Telephone number: 1-888-4-PLASTIC (1-888-475-2784)
Internet address: www.plasticsurgery.org
Information about breast reconstruction and referral to a board certified plastic surgeon.

Food and Drug Administration Consumer Information Line
Telephone number: 888-463-6332
Internet Address: http://www.fda.gov or http://www.fda.gov/cdrh/breastimplants/indexbip.html
Information on breast implants

National Cancer Institute
Telephone number: 800-4-CANCER
TTY: 800-332-8615
Internet Address: http://www.cancer.gov or http://www.clinicaltrials.gov
Information on clinical trials and patient educational materials in Physician’s Desk Query (PDQ)

Y-Me National Breast Cancer Organization
Telephone number: 800-221-2141 (National hotline)
Telephone number: 800-986-9505 (Spanish hotline)
Internet address: http://www.y-me.org
Y-ME materials and services include:

• a national hotline staffed by trained peer counselors who are breast cancer survivors (male and female)
• Men's Match Program, which matches men with other men who are supporting a wife or family member who has breast cancer
• materials about breast health (including fibrocystic breast changes) and breast cancer
• monthly educational and support meetings throughout the country
• information on comprehensive breast centers and treatment and research hospitals
• referral to support groups nationwide
• wig and prosthesis banks

Self-Help for Women with Breast or Ovarian Cancer (SHARE)
Telephone number: 866-891-2392 (toll free) or 212-382-2111
Internet address: http://www.sharecancersupport.org
SHARE operates 3 hotlines for anyone who has a concern about breast or ovarian cancer (the third is for Spanish callers). Hotline volunteers are breast or ovarian cancer survivors.

*Inclusion on this list does not imply endorsement by the American Cancer Society.

The American Cancer Society is happy to address almost any cancer-related topic. If you have any more questions, please call us at 1-800 ACS 2345 at any time, 24 hours a day.

Breast Reconstruction Following Breast Removal. American Society of Plastic Surgeons. Available at: www.plasticsurgery.org/public_education/procedures/breastreconstruction.cfm.

Farhadi J, Maksvytyte GK, Schaefer DJ, Pierer G, Scheufler O. Reconstruction of the nipple-areola complex: an update. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2006; 59: 40-53.

FDA Breast Implant Consumer Handbook - 2004. Available at: www.fda.gov/cdrh/breastimplants/indexbip.html.

Guerra AB, Metzinger SE, Bidros RS, Gill PS, Dupin CL, Allen RJ. Breast reconstruction with gluteal artery perforator (GAP) flaps. Annals of Plastic Surgery. 2004 Feb; 52(2): 118-125.

Kim SM, Park JM. Mammographic and ultrasonographic features after autogenous myocutaneous flap reconstruction mammoplasty. Journal of Ultasound in Medicine. 2004 Feb; 23(2): 275-82.

Kufe, DW, Pollack, RE, Weichselbaum, RR, Bast, RC, Gansler, TS, Holland, JF, Frei, E. Cancer Medicine, 6th ed. Hamilton, Ontario: B.C. Decker; 2003.

Resnick B, Belcher AE. Breast Reconstruction. American Journal of Nursing. 2002; 102: 26-33.

Taylor CW, Horgan K, Dodwell D. Oncological aspects of breast reconstruction. The Breast. 2005; 14: 118-130.

Winer EP, Morrow M, Osborne CK, Harris JR. Malignant Tumors of the Breast. In DeVita VT, Hellman S, Rosenberg SA (eds) Cancer Principles and Practice on Oncology, 6th ed. Philadelphia, Pa: Lippincott Williams and Wilkins; 2001.

Revised: 09/06/2007