Breast reconstruction

If you choose to have a breast reconstruction, your own breast surgeon may have the expertise to do this if they have training in plastic surgery techniques (known as an oncoplastic surgeon). Another option is that you may be referred to a reconstructive surgeon (also known as a plastic surgeon).

The breast surgeon and the reconstructive surgeon may work together to do the breast cancer surgery and reconstruction during the same operation.

Talk to your surgeon about what to expect, their experience and expertise, and the risks that are associated with the different types of reconstructions. You can also ask to see photographs of their work.

Finding a surgeon

When considering having a reconstruction, ask to be referred to an expert in breast reconstruction. Check that they are a member of Breast Surgeons of Australia & New Zealand (BreastSurgANZ), and, if they are a reconstructive surgeon, a member of the Australian Society of Plastic Surgeons.

Which health professionals will I see?

In hospital, you will be cared for by a range of health professionals who specialise in different aspects of a reconstruction procedure. Specialists and other health professionals will take a team-based approach to your care as part of a multidisciplinary team (MDT).

The health professionals listed below may be in your MDT.

breast surgeon – performs breast surgery and biopsies; some breast surgeons also perform breast reconstruction and plastic surgery procedures

oncoplastic breast surgeon – specialises in using plastic surgery techniques to reconstruct breast tissue after surgery

reconstructive (plastic) surgeon – performs breast reconstruction after a mastectomy

anaesthetist – administers anaesthetic before surgery and monitors you during the operation

breast care nurse – provides breast cancer care; provides information and referrals during and after treatment

occupational therapist, physiotherapist – assist with physical and practical problems, including restoring movement and mobility after surgery and recommending aids and equipment

social worker – links you to support services and helps you with any emotional, practical and financial problems

counsellor, psychologist, psychiatrist – help you manage your emotional response to diagnosis and treatment

Types of breast reconstruction

The main types of breast reconstruction are implant reconstruction or flap reconstruction (or a combination of the two). An immediate reconstruction can be combined with a total mastectomy or a mastectomy that keeps the skin, or both the skin and nipple.

Most reconstructions involve two or more operations several weeks or months apart. Your reconstructive surgeon will discuss the different techniques and suggest the most suitable one for you. Your reconstruction options will depend on several factors, including:

• your body shape and build
• your general health
• the surgeon’s experience
• the amount of tissue that has already been removed
• any scars from other operations
• the quality of the remaining skin and muscle
• the breast size you would like
• whether one or both breasts are affected
• whether you need radiation therapy or have already had it
• whether you smoke – this affects the type and timing of the reconstruction you can have, as some operations have a higher risk of complications in smokers or women who have recently quit.

Skin- and nipple-sparing mastectomy and breast reconstruction

You may be able to have a mastectomy that preserves the skin, or both the skin and nipple (called skin-sparing mastectomy or nipple-sparing mastectomy).

In these operations the breast tissue is removed, but most or all of the skin (and sometimes the nipple) is preserved. This often makes the reconstruction look more natural and any scars are usually less visible. Some type of immediate reconstruction is also performed at the same
time as the mastectomy to fill out the skin.

These operations are not suitable for all types of breast cancer, so you should discuss this option with your breast cancer surgeon.

An implant is a sac that’s filled with either silicone gel or a saltwater solution (saline). It is surgically inserted into the body to replace the removed breast tissue and create a new breast shape.

There are benefits and drawbacks to having an implant. You need to discuss these with your surgeon. You may also find it helpful to talk with someone who has an implant – Cancer Council 13 11 20 or a breast care nurse may be able to put you in touch with someone.

Woman with an implant reconstruction – After the reconstruction you will have a scar on your breast.

Types of implants

Silicone implants – These are used in almost all operations. A softer, honey-like type of gel was previously used, but implants are now made of a soft, semi-solid filling called cohesive gel. This gel is quite firm and holds its shape like jelly.

The surface texture of these implants can be smooth or have a rough (textured) surface. The rougher textured implants are called macro textured; the less textured implants are called micro textured. Textured implants grip to tissue better and are less likely to move position than smooth implants. Some textured implants have been removed from sale because of a rare side effect.

Saline implants – These are made of a solid silicone envelope filled with sterile saltwater (saline). They are no longer often used in reconstruction. Saline breast implants don’t look and feel as natural as silicone implants. They may gradually lose volume, deflate without warning or wear out. Skin wrinkling and “sloshing” may also occur.

How an implant reconstruction is done

An implant reconstruction can be done in one operation or as a two-stage operation.

One-stage operation – This operation is sometimes called a direct-to-implant reconstruction. It is done when there is enough tissue left on the chest to cover the implant. The surgeon inserts the implant either beneath the chest (pectoralis) muscle or in front of this muscle. The operation is usually done at the same time as a skin- or nipple-sparing mastectomy.

An acellular dermal matrix or a synthetic mesh is often used to cover all or part of the implant. This helps keep the implant in place.

Two-stage operation – In the first operation a balloon-like bag called an inflatable tissue expander is placed under the skin and often beneath the chest muscle. In some cases, it can be placed in front of the chest muscle. Every couple of weeks, the balloon is injected with saline through a port (a thin tube with an opening just under the skin). You may be given 1–6 injections depending on how much the skin and muscle need to stretch. The stretched tissue creates a pocket for the breast implant.

When the expander has stretched the tissue enough, the surgeon removes the temporary expander and replaces it with a permanent silicone or saline implant in a second operation. You may need to stay in hospital overnight after this second operation.

Acellular dermal matrix and synthetic mesh

If there is not enough tissue to cover the entire implant other material called acellular dermal matrix (ADM) is used. This may be made from animal (cow or pig) or human tissue. The ADM is processed and sterilised for use in surgery. It is cut to size and modelled to the shape of the breast.  Sometimes a synthetic mesh is used instead. When in place, the ADM or mesh works like building scaffolding – it is there to support and contain the
breast implant. Your existing skin will grow into the ADM or mesh as the area heals.

Placement of a breast implant

During a breast implant reconstruction the surgeon can place the implant above or below the chest (pectoralis) muscle.

Subpectoral implant reconstruction – Breast implant placed beneath the chest (pectoralis) muscle. This is called a subpectoral implant reconstruction. The lower and outer part of the implant is often covered by a dermal matrix or mesh to hold the implant in place.

Prepectoral implant reconstruction – Breast implant placed in front of the chest (pectoralis) muscle, directly under the skin and subcutaneous tissue (the layer of tissue just under the skin). This is called a prepectoral implant reconstruction. The whole of the implant is covered by a dermal matrix or mesh to hold the implant in place.

Your surgeon will discuss the most suitable method for you.

Stages of delayed breast reconstruction with a tissue expander

Before the tissue expander process – The chest tissue is mostly flat, because breast tissue and skin was removed during the mastectomy.

Implanting the tissue expander – Inserting the tissue expander creates a pocket for the implant. There is a port through which the saline can be injected. The saline injections usually cause little pain.

Expanding the tissue expander – The tissue stretches and expands each time saline is added. You may feel discomfort for a few days. When the expander has stretched the tissue enough the expander is removed and the implant is inserted in its place.

Risks of having an implant reconstruction

Before the operation, the surgeon will discuss the risks of an implant reconstruction with you. Some of these risks are covered below.

Infection – You’ll be given antibiotics at the time of the operation to reduce the risk of infection. If this does happen, the implant usually has to be removed until the infection clears. The implant can then be replaced with a new one.

Implant rupture – Implants don’t last a lifetime. They can leak or break (rupture) because of gradual weakening of the silicone over time. It is recommended that implants are replaced after 10–15 years, or earlier if there are any problems. Your surgeon or GP should check your implants each year.

If a saline implant ruptures, salty water will leak into your body. The salty water is not harmful, but you will need to have surgery to remove the empty silicone envelope and replace the implant.

Hardening of the implant – A fibrous covering can form around a breast implant. If this hardens over time, it may make the reconstructed breast feel firm. This is called capsular contracture, and it is more common after radiation therapy. Capsular contracture can be uncomfortable or painful and may change the shape of the breast. Additional surgery may be needed to remove or replace the implant.

Movement – The position of the implant in the body may change slightly over time. This is called implant displacement, descent or rotation. In a small number of cases, the implant shifts a lot and changes the shape of the breast. Further surgery can restore the implant to its original position.

Visible rippling – Sometimes implants adhere to the surface of the skin and this can affect how smooth the breast is. This can often be corrected with minor surgery such as lipofilling (the injection of fat from another part of the body under the skin).

Other health problems – There have been reports of a link between a type of non-Hodgkin lymphoma and textured breast implants. This is known as breast implant associated anaplastic large cell lymphoma (BIA–ALCL) and it is rare. The Therapeutic Goods Administration (TGA) recommends women monitor their breasts for any changes such as sudden fluid collection. Implants should be checked yearly by your surgeon or GP.

You can read more about BIA–ALCL on the TGA’s website. The TGA also has an online breast implant hub, where information and support related to breast implants and their safety are updated as new information becomes available. If you are concerned, talk to your surgeon.

Research has not established that silicone breast implants cause autoimmune disorders such as scleroderma, rheumatoid arthritis or lupus. There is also no evidence that implants cause breast cancer.

Keeping up to date about the safety of your breast implants

While implants are generally considered to be safe, there have been some concerns about risks.

Some silicone implants were voluntarily taken off the market in the 1990s due to safety concerns. Since then, regulatory authorities such as the Therapeutic Goods Administration (TGA) must approve brands that are used in Australia.

In April 2010, the French breast implant brand Poly Implant Prothèse (PIP) was withdrawn due to safety concerns and a possible increased likelihood of ruptures. About 5000 Australians had a PIP implant between 2000 and 2010, but most of these were cosmetic procedures.

In late 2019 the TGA removed from sale some textured breast implants and imposed extra conditions on others because of concerns over BIA–ALCL
(see above). Women who are worried about the safety of their implant should discuss any concerns with their surgeon.

The Australian Breast Device Registry (ABDR) is a national clinical quality registry for all people having breast implant surgery. Its aim is to provide a
way to track how the products perform and what the patient outcomes are after surgery. This can help identify early signs of problems with a device.

ABDR is supported by the Australian Society of Plastic Surgeons, Breast Surgeons of Australia & New Zealand and the Australasian College of
Cosmetic Surgery. Your surgeon will provide you with printed information about the registry and you’ll be contacted by ABDR after the surgery with
more information. For more details visit ABDR or ask your surgeon.

What to consider – implant reconstruction

Benefits

• Operation takes only a few hours and you usually only stay in hospital for a few days.
• Creates the breast shape without moving tissue (muscle, skin or fat) from elsewhere in the body, so other parts of the body aren’t affected.
• There is only one scar from the mastectomy.
• Recovery time at home is shorter than for a flap reconstruction. Although the chest area will be swollen and sensitive, you may be able to return to most activities within about a week.
• Implants come in a range of shapes and sizes. You can choose to change your original breast size.
• Operation doesn’t cause issues, such as muscle weakness, that may occur after a flap reconstruction

Drawbacks

• May not be suitable if you plan to have radiation therapy.
• Two or more operations may be needed. If you have an expander first, you are likely to need regular doctor’s visits to gradually fill the expander. The whole process may take 3–6 months.
• A breast reconstructed with a tissue expander and/or an implant usually feels firmer than a natural breast. It won’t move like a natural breast, but it usually looks the same in a bra.
• If your other breast changes in shape and size, you may need more surgery to match the two.
• Hardened scar tissue (capsule) may form around the implant. This can distort the shape of the breast and may be painful.
• Risk of infection, which may mean removing the implant.
• Implants may need to be replaced after 10–15 years.
• There are some rare side effects.

The shape of a breast can be built using your own muscle, fat and skin from another area of the body. This is called a flap reconstruction. There are a number of different types of flap reconstructions. These are covered below.

A flap reconstruction may suit women who have large breasts, women who don’t have enough skin to cover an implant or women who have had radiation therapy. This type of reconstruction may not be suitable for women with diabetes, connective tissue disease or vascular disease; women who have had previous major abdominal surgery; or women who smoke.

Flap from the lower abdomen

The tissue from the lower abdomen (belly) is moved to the chest area to reconstruct the breast shape. There are two main types of abdominal flaps: a free transverse rectus abdominis myocutaneous (TRAM) flap and a newer type called a free deep inferior epigastric perforator (DIEP) flap. These flaps are called free flaps because the flap is cut completely away from the blood supply in the abdomen. The surgeon then reconnects the flap to the blood vessels in the chest area using microsurgery (surgery using miniature instruments and viewed under a microscope).

DIEP flap reconstructions are now done more often than TRAM flap procedures. In a DIEP flap procedure, the surgeon uses only the skin and fat to reconstruct the breast. The abdominal muscle is left in place. This means the strength of your abdomen is not affected and there is less risk of abdominal problems after surgery. This type of reconstruction is called DIEP because it uses the deep blood vessels called deep inferior epigastric perforators.

In a free TRAM flap procedure, all or some of the muscle in the lower abdomen and a flap of local skin and fat is moved to the chest to form the reconstructed breast. The muscle in the lower abdomen that runs from the breastbone to the pubic bone is the rectus abdominis muscle.

Because the reconstructed breast is formed from tissue from the abdominal area, a DIEP or TRAM flap reconstruction means your abdomen is tighter and flatter (“tummy tuck”). You will have a long scar across the lower abdomen from one hip to the other and a scar on the reconstructed breast. You will have little to no feeling in the skin over the breast.

Another type of TRAM flap reconstruction that is no longer often done is called a pedicle TRAM flap. In this procedure, the flap remains attached to its original blood supply and is tunnelled under the skin of the upper abdomen to the breast.

Woman with a DIEP flap reconstruction – After the reconstruction you will have a scar on your breast and a scar across your abdomen from one hip to the other (seen only faintly here).

Flap from the back (LD flap reconstruction)

The latissimus dorsi (LD) is a muscle on the back under the shoulder blade. The surgeon moves this muscle and some skin and fat from the back around to the chest to make a reconstructed breast.

This reconstruction can be completed in one operation, but the surgeon will usually place an implant under the flap to create a breast that is similar in size to your remaining breast. If you have a tissue expander, the surgeon will begin the expansion process after the flap has healed. Unless you have a nipple-sparing mastectomy, the areola and nipple are created in a separate operation.

The scar on the back is usually straight and can be covered by your bra strap. The scar on the breast will vary depending on the type of mastectomy you had.

Some surgeons use a scarless LD flap reconstruction method that avoids a scar on the back. The mastectomy scar is reopened and special  instruments are used to bring the latissimus dorsi muscle forward toward the breast. Ask your surgeon if this is suitable for you.

Woman with an LD flap reconstruction – After the reconstruction you will have a scar on your breast.

Location of flap reconstructions

The tissue for reconstructing your breast can come from different places. Your doctor will discuss the best location with you.

DIEP flap and TRAM flap – Takes skin and fat, but no muscle, from the lower abdomen.

LD flap – Takes skin, fat and muscle from the back.

Less common types of flap procedures

If a DIEP, TRAM or LD flap is not suitable, you may be offered reconstruction techniques that use fat and a blood supply from other areas of the body. These include:

• superior gluteal artery perforator (SGAP) flap or inferior gluteal artery perforator (IGAP) flap using tissue from the bottom
• transverse myocutaneous gracilis (TMG) flap or transverse upper gracilis (TUG) flap using tissue from the inner thigh.

To help reconstruct a small breast shape, the surgeon may remove fat from another part of the body (liposuction), then inject it into the breast to create or improve the shape and contour. Sometimes the surgeon may build a whole new small breast. This is called lipofilling.

SGAP or IGAP flap – Takes fat and skin from the upper or lower bottom.

TMG or TUG flap – Takes skin, fat and a small amount of muscle from the upper inner thigh.

Risks of having a flap reconstruction

Before the operation, the surgeon will discuss the risks of a flap reconstruction with you. Some of these risks are covered below.

Loss of the flap – Blood vessels supplying the flap may kink or get clots, leading to bleeding and a loss of circulation. This may cause the tissue to die, leading to a partial or complete loss of the flap. This is more common in women who smoke or have recently quit. Quitting smoking before surgery will help you to decrease the risk.

In rare cases, the fat used to make a TRAM or DIEP flap doesn’t get enough blood supply and dies. This is known as fat necrosis. The affected areas in the reconstructed breast can feel firm and are easily seen and diagnosed on a mammogram. They can be left in place or surgically removed. Women who smoke or have had radiation therapy are more at risk of fat necrosis.

Problems with the donor site – After having an abdominal flap reconstruction, some women find it takes a while for the wound to heal. After an LD flap reconstruction it’s common for fluid to build up (seroma).

Hernia (abdominal bulge) – Women who have a TRAM or DIEP flap have a small risk of having a hernia. A hernia occurs when part of the bowel juts out through the abdominal wall. The risk is greater with a TRAM flap than with a DIEP flap reconstruction because the muscle that is removed in a TRAM flap can weaken the abdominal wall and cause a hernia.

What to consider – flap reconstruction

Benefits

• Reconstruction is permanent once the breast has healed, even though additional treatment or follow-up surgeries are sometimes needed.
• Most methods only use your own living tissue to create the breast. This often results in a more natural look and feel.
• The flap maintains its look and feel over the long term and generally adjusts if your body weight changes.
• Using your own tissue means there is no risk of possible rupture.
• Less chance of long-term complications needing additional surgeries later in life.

Drawbacks

• The operation will take several hours and you may need to stay in hospital for about a week. Recovery takes longer than after an implant  reconstruction as there is a wound at the site where the flap was taken and a breast wound to heal.
• Risks include infection and the flap not healing properly.
• Surgery usually causes more than one scar (but these fade).
• Depending on the type of flap you may also need an implant.
• DIEP and TRAM procedures can be done only once.
• There is a small risk of hernia with abdominal flaps.

Some women decide they only want the shape of the breast reconstructed, others choose to have a nipple reconstruction to make their breast look complete. The appearance of the nipple and the areola (the brown or pink rim of tissue around the nipple) can be created in several ways.

Adhesive nipples – These stick to the skin and stay in place for several days. They are available from breast prostheses suppliers.

Nipple made from your own body tissue – A small operation can reconstruct a nipple and the areola. This operation is generally done a number of months after a reconstruction to give your body time to heal from the original operation and because the reconstructed breast may sag slightly after surgery. Nipple reconstruction is done using tissue from your remaining nipple, if you have one, or with tissue from the new implant or flap. The new nipple won’t have nerves, so it will not feel any sensation or become erect to touch.

Woman with a reconstructed breast and nipple (no tattoo) – After the reconstruction you will have a new nipple.

Nipple tattoo – If you have a natural breast remaining, the new nipple can be tattooed to match the colour of the other nipple. Most reconstructive surgeons can do the tattooing or you can have it done by a trained nurse, a professional medical tattooist or a specially trained cosmetic therapist. Initially, the tattoo will look darker than the remaining nipple, but it will fade with time to match in colour.

For many women, the small differences between their remaining and reconstructed breasts are not noticeable when they wear a bra. For others, the difference in breast size may be more obvious. Some women decide to have the remaining breast made smaller or larger by surgery to match the reconstructed breast and improve balance and posture.

Bilateral mastectomy

Some women may be advised or choose to have a bilateral mastectomy. This means both breasts are surgically removed. A bilateral mastectomy may be recommended for several reasons:

• the type of breast cancer you have
• your risks and/or anxiety about developing another breast cancer
• family history or a gene fault that increases your breast cancer risk
• the amount of surgery required to achieve a symmetrical result with the breast reconstruction
• choosing an abdominal flap reconstruction; because surgery on the abdomen can only be done once, the flap procedure can’t be repeated at a later date if cancer develops in the other breast.

Reconstruction will need to be considered for both breasts. Discuss this issue with your doctor and seek a second opinion if you wish.

Therapeutic mammaplasty

This procedure combines surgery to remove part of the breast (breast conserving surgery or wide local excision) with a breast reduction. It is often used as an alternative to mastectomy in suitable cases. Sometimes a breast reduction is done on the other breast at the same time, or at a later date.

The type of surgery you’ve had will affect the side effects you experience. Not all women have side effects, but most experience at least one.

Appearance of the breast – It’s natural to feel nervous when the bandages and dressings are first removed. The look of the reconstructed breast will improve as the bruising and swelling lessen. The appearance of a breast reconstruction using a tissue flap may take longer to settle. Your self-esteem is likely to be affected.

Pain relief – For any type of operation, you will be given pain relievers to ease your discomfort. You will also probably have small tubes inserted into the operation site so fluid can drain away. If you have had a flap reconstruction, you will be sore in the area where the muscle and other tissue were taken, as well as in the breast area.

Healing problems – Sometimes the area will not heal well within the first week or so after surgery. This can be caused by infection, poor blood supply or problems with an implant. Any infection must be treated to reduce the possibility of further complications. If an implant has been used, it might need to be taken out. It may be possible to have a new implant put in at a later date.

Bleeding – Blood may build up in or under the wound. This is called a haematoma, and it causes swelling and pain. A large haematoma may need to be removed by surgery.

Seroma – In some cases, when drains have been removed, extra fluid collects in or under the wound. This is called a seroma, and it causes swelling and pain. It may need to be drained by a health professional using a needle. You can wear a special bra called a compression bra to help relieve the pain.

Scars – Everyone heals differently, and the final appearance of a scar will vary from woman to woman, even if the surgery is the same. Most scars have a thickened, red appearance at first, but usually fade after about three months.

Sometimes the scar stays thick and becomes itchy and  uncomfortable. Let your surgeon know if you have other existing raised, irregular scars (sometimes called keloid scars), as this may show that you are prone to getting these types of scars. Your surgeon or breast care nurse can advise you about treatments to reduce the discomfort. You may be able to have further surgery to improve the scar’s appearance.

Pregnancy – Breast reconstruction doesn’t affect your ability to become pregnant or carry a baby. There is a small risk of having a hernia during pregnancy if you had an abdominal flap reconstruction. Your doctor will talk to you about any risks you may have.

Breastfeeding – It will not be possible to breastfeed with the reconstructed breast. Most women can breastfeed successfully with their other breast, although this may be difficult if you have had a reduction surgery in this breast. Talk to a breast care nurse or lactation consultant about any concerns you have about breastfeeding after a reconstruction.

Taking care of yourself after a reconstruction

Your recovery time will depend on your age, general health and the type of surgery you had. Most women feel better within 1–2 weeks and can return to their normal activities after 4–8 weeks.

Rest – When you get home from hospital, you will need to take things easy for the first weeks. Ask family and friends to help you with chores so you can rest.

Driving – You will probably need to avoid driving for 2–6 weeks after surgery. Discuss this timing with your breast surgeon.

Lifting – Avoid repetitive arm movements, such as hanging out washing or vacuuming, and heavy lifting (more than 5 kg) for four weeks after surgery. Heavy lifting includes carrying shopping bags. You can gradually return to normal activities, including lifting from 4–8 weeks.

Tummy problems – You may have some weakness in your abdomen after abdominal flap surgery. Take care getting up from a low chair or sitting up in bed. You will be encouraged to wear supportive underwear. If you still have weakness after six weeks, ask your doctor about visiting a physiotherapist or an exercise physiologist for an exercise program.

Follow-up appointments – Your surgeon will continue to care for you until your body has healed. Then you will have regular check-ups with your breast specialist.

Before you have surgery, find out how much it will cost to have a breast reconstruction. Check with your surgeon, the hospital, Medicare and your private health fund, if you have one, before deciding to go ahead. Find out whether you may need to pay for extras. These may include pain medicines, post-surgical bras and check-ups with your breast surgeon.

There are services available to help with other costs associated with a reconstruction. These can include transport costs to attend medical  appointments and the cost of prescription medicines. Ask the hospital social worker which services are available in your local area and if you are eligible to receive them.

If you need legal or financial advice, you should talk to a qualified professional about your situation. Cancer Council offers free legal and financial service for people who can’t afford to pay – call 13 11 20 to ask if you are eligible.

If you have your nipple tattooed, there is a Medicare rebate for this if the tattooing is done by a health professional with a Medicare provider number. You can also ask your private health fund, if you have one, if they cover the cost for this.

What to consider – reconstruction costs

Public hospital

• Reconstruction after a mastectomy is a medical procedure, not a cosmetic one, so the costs are covered through Medicare for a public patient in a public hospital.
• There may be some extra charges if an implant is used.
• There may be some charges for private patients who have a reconstruction in a public hospital.
• If you choose to have a delayed reconstruction, you will be put on the hospital’s elective surgery waiting list. You may need to wait many months for the operation. Ask your surgeon how long you might have to wait.
• You can put your name on a waiting list even if you’re not sure that you want a reconstruction.

Private hospital

• Private patients may be covered by their private health insurance or may have to pay the cost themselves.
• In a private hospital, Medicare will cover some of the surgeon’s and anaesthetist’s fees. Your health fund may cover some or all of the remaining costs, but you may need to pay a gap fee or a hospital admission fee.
• Part or the entire cost of an inflatable tissue expander and any permanent implant may also be covered by your insurance provider.
• If you decide to join a health fund before your operation, you will have to wait the qualifying period before you can make a claim. This may be up to 12 months. Check with the different health funds.