This Peg Procedures Questions and Answers are divided into four sections:

Background information
Costs, insurance, pre-existing conditions, health evaluation, etc.

Surgery
What to expect during surgical procedures

Recovery
Length of time and restrictions

Results
What to expect long-term following the Peg Procedures

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Background Information

Q: How much does the Peg Procedure cost?

A:Professional fees and hospital costs will vary in different geographical areas. In general, the Peg techniques are competitively priced with other procedures and can be less expensive than older kinds of reconstruction because they require fewer surgeries.

Q: Will my insurance pay for this procedure?

A: Most insurance companies will cover breast reconstruction, but very few standards exist as to the level at which patients will receive these benefits. More standardization is required so patients with breast cancer can be assured of adequate coverage.

Q: Are there exercises I can do before the Peg Procedure to help me recover faster?

A: There are no specific exercises that are required. However, the most important preparation for surgery is the cessation of smoking. Obviously, being in good health and physical shape will hasten recovery.

Q: Why are you so concerned about lumpectomies and radiation therapy?

A: There are four areas of concern:
1) Lumpectomy with radiation therapy has not been used for a long enough period of time to accurately assess long term recurrence rates of breast cancer.
2) With lumpectomy and radiation, the woman keeps her residual breast tissue that may be the source of recurrence at a later date.
3) This residual breast tissue can have severe radiation scarring which may complicate follow-up monitoring with mammography.
4) Most patients will require a modified radical mastectomy to treat a local recurrence if they were initially treated with lumpectomy and radiation. The presence of radiation scarring within a mastectomy will severely compromise any method of breast reconstruction.

Q: Do I have to have chemotherapy with the Peg Procedure?

A: In most circumstances, the decision to have chemotherapy is made independent of the type of treatment that is given to the breast itself. Instead, the perceived risk of systemic spread from the breast cancer is the main determinant for chemotherapy. Premenopausal women with larger breast cancers that have positive lymph nodes are more likely to need chemotherapy because they are at a higher risk for systemic spread.

Q: I've already had a mastectomy on my left breast and had it reconstructed. Can you improve the appearance with another operation?

A: Most patients can benefit from a surgical revision when the results of the reconstruction are not optimal.

Q: I had a lumpectomy with radiation with on my breast already, and now it has cancer again. Can I get the Peg Procedure?

A: Patients previously treated with radiation to the breast can have their breast reconstructed even though the results of the reconstruction will be severely compromised by the presence of radiation scarring in the skin and soft tissue.

Q: I had a lumpectomy and radiation on my left breast. Now I have cancer in my right breast. Can I still have the Peg Procedure?

A: Yes. The tissues of the right breast should not be adversely affected by radiation therapy to the left breast.

Q: Can I have both breasts lifted or made bigger at the time of the Peg?

A: Most patients can simultaneously have the size and the shape of their breasts altered during the Peg Procedure.

Q: Can I have a breast reduction at the time of the Peg?

A: Yes, most patients can have the size of their breasts reduced at the same time.

Q: Which Peg Procedure is best, the one where you use my shoulder or stomach muscle, or the one where I come back for an implant? Who decides, and how am I involved in the decision? What are the tradeoffs?

A: Ultimately, it is the patient who chooses the type of procedure that she wants. A Peg Flap reconstruction from the back or abdomen provides equally good results. A Peg Flap is used when the patient does not want a breast implant. Generally these procedures are more extensive than the Pectoralis Peg which uses a breast implant instead of a flap.