8.3 Post-Mastectomy Reconstruction & Oncoplastic Surgery

CBCN Certified Breast Care Nurse Exam

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1 Introduction: The CBCN Exam

CBCN Exam Facts, 2026 Blueprint & Study Plan

2 Chapter 1: Breast Health, Examination & Benign Conditions (Care Continuum)

1.1 Breast Anatomy, Vascular Supply & Hormonal Physiology 1.2 Clinical Breast Examination & Breast Awareness Education 1.3 Benign Breast Conditions, Mastalgia & Fibrocystic Changes

3 Chapter 2: Screening, Breast Density & Special Populations (Care Continuum)

2.1 Screening Modalities, Breast Density & Pharmacologic Risk Reduction 2.2 Screening & Breast Health in Special Populations

4 Chapter 3: Cancer Risk Assessment & Genetics (Care Continuum)

3.1 Proliferative Lesions, Atypia & High-Risk Benign Pathology 3.2 Breast Cancer Risk Models (Gail, Tyrer-Cuzick, Claus, BRCAPRO) 3.3 Hereditary Cancer Syndromes & Genetic Evaluation

5 Chapter 4: Patient Navigation, Surveillance & Survivorship (Care Continuum)

4.1 Patient Navigation, Barriers to Care, Social Determinants & Interprofessional Collaboration 4.2 Survivorship Care Planning, Surveillance Intervals & Recurrence Monitoring 4.3 Secondary Prevention, Physical Activity, Nutrition & Wellness Guidance

6 Chapter 5: Carcinogenesis & Diagnostic Evaluation (Diagnosis and Staging)

5.1 Carcinogenesis: How Breast Cancer Develops and Spreads 5.2 Clinical Assessment, Diagnostic Imaging & BI-RADS Categorization 5.3 Breast Biopsy Modalities & Image-Guided Localization Techniques

7 Chapter 6: Pathology, Biomarkers & Genomic Testing (Diagnosis and Staging)

6.1 Histopathology: In Situ Carcinomas & Invasive Carcinoma Subtypes 6.2 Receptor Biomarkers (ER, PR, HER2, Ki-67) & Molecular Subtypes 6.3 Multigene Genomic Assays & Recurrence Risk Stratification

8 Chapter 7: Clinical & Pathologic Staging (Diagnosis and Staging)

7.1 AJCC TNM Staging System (Anatomic vs Prognostic Staging) 7.2 Staging Workup: When to Use MRI, CT, Bone Scan & PET

9 Chapter 8: Breast Surgery, Axillary Staging & Reconstruction (Treatment Modalities)

8.1 Breast-Conserving Surgery, Margin Standards & Mastectomy Techniques 8.2 Axillary Staging: Sentinel Lymph Node Biopsy vs. Axillary Dissection 8.3 Post-Mastectomy Reconstruction & Oncoplastic Surgery

10 Chapter 9: Radiation Therapy & Chemotherapy (Treatment Modalities)

9.1 Radiation Therapy: Whole Breast, Chest Wall, Regional Nodal & Partial Breast Irradiation 9.2 Neoadjuvant vs. Adjuvant Chemotherapy Principles & Standard Regimens

11 Chapter 10: Endocrine, HER2-Targeted & Novel Systemic Therapies (Treatment Modalities)

10.1 Endocrine Therapy: SERMs, Aromatase Inhibitors, Ovarian Suppression & SERDs 10.2 HER2-Targeted Monoclonal Antibodies, Antibody-Drug Conjugates & Kinase Inhibitors 10.3 CDK4/6 Inhibitors, PARP Inhibitors & Immune Checkpoint Blockade 10.4 Trop-2 Antibody-Drug Conjugates, PI3K/AKT/mTOR Inhibitors & New Oral SERDs

12 Chapter 11: Specific Conditions & Special Populations (Treatment Modalities)

11.1 Triple-Negative Breast Cancer: Treatment Considerations 11.2 HER2-Positive Breast Cancer: Treatment Considerations 11.3 Inflammatory Breast Cancer & Paget Disease of the Nipple 11.4 Phyllodes Tumors & Breast Angiosarcoma 11.5 Treatment Considerations for Special Populations

13 Chapter 12: Symptom Management & Supportive Care (Nursing Practice)

12.1 Acute Chemotherapy Toxicities, Supportive Regimens & Oncologic Emergencies 12.2 Lymphedema Pathophysiology, ISL Staging & Complete Decongestive Therapy (CDT) 12.3 Musculoskeletal Toxicities, Bone Health & Vasomotor/GSM Relief 12.4 Complementary & Integrative Modalities 12.5 Cancer Rehabilitation: Physical, Occupational & Pelvic Floor Therapy

14 Chapter 13: Oncologic Emergencies (Nursing Practice)

13.1 Oncologic Emergencies I: Spinal Cord Compression, Hypercalcemia, Tamponade & SVC Syndrome 13.2 Oncologic Emergencies II: Hypersensitivity & Anaphylaxis, Sepsis, Pleural Effusion & Thromboembolism

15 Chapter 14: Professional Practice, Clinical Trials & Self-Care (Nursing Practice)

14.1 Professional Practice: Guidelines, Ethics, Legislation, Outreach & Accreditation 14.2 Clinical Trials in Breast Oncology 14.3 Nurse Self-Care: Compassion Fatigue, Burnout, Moral Distress & Substance Use

16 Chapter 15: Psychosocial Dimensions of Care (Psychosocial Dimensions)

15.1 Psychosocial Distress, Coping, Grief & Palliative Care 15.2 Culture, Spirituality, Sexual & Gender Identity, Age & Healthcare Disparities 15.3 Family & Caregiver Dynamics 15.4 Altered Body Image 15.5 Reproductive & Sexual Health

8.3 Post-Mastectomy Reconstruction & Oncoplastic Surgery

Key Takeaways Explain This Topic AI

The Women's Health and Cancer Rights Act (WHCRA) of 1998 mandates federal insurance coverage for all stages of reconstruction of the diseased breast, contralateral symmetry procedures, internal and external prostheses, and physical complications of mastectomy including lymphedema.

Prosthetic reconstruction predominantly utilizes a two-stage approach with a tissue expander followed by a permanent silicone or saline implant, supported by acellular dermal matrix (ADM) in either a subpectoral or prepectoral anatomical pocket.

Prepectoral implant placement avoids disturbing the pectoralis major muscle, completely eliminating muscular animation deformity and reducing postoperative chest wall pain, but requires thick, well-vascularized mastectomy skin flaps.

The deep inferior epigastric perforator (DIEP) flap is the autologous gold standard, microvascularly transferring lower abdominal skin and adipose tissue while completely sparing the rectus abdominis muscle and anterior sheath to minimize donor-site hernia and bulge.

Postoperative autologous flap monitoring requires intensive hourly assessments of skin temperature, color, capillary refill (1-2 seconds), and Doppler ultrasound signals, where dusky discoloration, brisk refill under 1 second, and dark bleeding signal emergency venous congestion requiring immediate surgical re-exploration.

Last updated: September 2026

Reconstructive Legislation, Timing Paradigms & Surgical Decision-Making

Breast reconstruction following mastectomy represents an essential, restorative component of comprehensive breast cancer survivorship. It restores anatomical symmetry, clothes fit, and body image, mitigating the psychological trauma associated with amputation of the breast.

The Women's Health and Cancer Rights Act of 1998 (WHCRA)

The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a landmark federal law signed into United States legislation to eliminate insurance barriers to breast reconstruction. The WHCRA mandates that any group health plan, commercial insurance company, or health maintenance organization (HMO) that provides coverage for medical and surgical benefits with respect to a mastectomy must also provide coverage for :

All stages of reconstruction of the breast on which the mastectomy was performed (including tissue expansion, permanent implant placement, or autologous flap transfers).

Surgery and reconstruction of the contralateral (unaffected) breast to produce a symmetrical appearance (including reduction mammaplasty, mastopexy [breast lift], or augmentation mammaplasty).

Prostheses (both external breast prostheses and internal implants) and specialized post-mastectomy brassieres.

Treatment of physical complications at all stages of mastectomy, including lymphedema (e.g. compression garments, manual lymphatic drainage, physical therapy).

Critical Legal Provisions : WHCRA sets no time limit on when a patient may elect to pursue reconstruction. It applies to group health plans and individual health insurance policies that cover mastectomy; Medicare and Medicaid are not governed by WHCRA, although both generally cover post-mastectomy reconstruction. A patient who underwent mastectomy 10 or 20 years ago retains full federal rights to reconstructive surgery and contralateral symmetry procedures. Breast care nurses serve as essential patient advocates in educating women about their federal protections under the WHCRA.

Reconstructive Timing Paradigms

Immediate Reconstruction : Initiated simultaneously with the oncologic mastectomy under the same general anesthetic.

Advantages : Single surgical event, superior psychological recovery, preservation of the native inframammary fold and skin envelope, and superior aesthetic symmetry.

Disadvantages : Longer initial operative time; if adjuvant chemotherapy is required, post-surgical wound complications (infection, skin flap necrosis) can potentially delay systemic treatment.

Delayed Reconstruction : Performed months to years following the completion of all oncologic therapies (mastectomy, chemotherapy, and radiation therapy).

Advantages : Prioritizes oncologic margin clearance and allows uncomplicated delivery of adjuvant therapies; provides the patient with dedicated time to deliberate reconstructive modalities.

Disadvantages : Requires multiple separate major operations; irradiated chest wall skin becomes contracted, fibrotic, and inelastic, frequently necessitating autologous flap tissue transfer rather than prosthetic expanders alone.

Delayed-Immediate Reconstruction (Two-Stage Hybrid) : Frequently utilized when post-mastectomy radiation therapy (PMRT) is anticipated. A temporary tissue expander is placed at the time of mastectomy to preserve the skin pocket and inframammary fold. Once final pathology confirms nodal involvement and PMRT is completed, the expander is removed 6 to 12 months post-radiation and replaced with a definitive autologous tissue flap (such as a DIEP flap). This prevents delivering high-dose ionizing radiation directly to a newly transferred vascularized autologous flap.