When 26-year-old Jennifer DiCocco noticed a suspicious lump in her breast during a self-breast exam, she ignored it. She was young and didn’t think she was at risk of breast cancer. Besides, as a third-year surgical resident, she knew that younger people her age had dense breast tissue and that most breast cancers occur in older women. No need to panic, she thought.

But months later, the lump was still there.

“I went to my boss, thinking the lump was likely a cancer,” DiCocco says. “She did an ultrasound, and we both thought it was probably cancer.”

Now very concerned, DiCocco moved quickly. She underwent a mammogram and ultrasound guided biopsy. (This special kind of biopsy uses ultrasound waves pulsed into the body to create an accurate picture of even very tiny abnormal tissue masses to be removed for a doctor’s examination.)

On the same day she received her lab test report, DiCocco went to see the cancer doctor (oncologist). The next day, she checked in with a plastic surgeon. (Plastic surgeons perform breast reconstructions.) “I chose to have a bilateral mastectomy [both breasts removed] and start an immediate breast reconstruction,” she says.

DiCocco is one of more than 254,000 American women who face breast cancer each year, according to the American Cancer Society. But she is also part of smaller group—breast cancer patients who opt for breast reconstruction after undergoing a mastectomy.

Breast reconstruction is a type of surgery for women who, like DiCocco, have had a breast removed. The surgery rebuilds the breast so that it is much the same size and shape as it previously was. In addition, doctors can add the nipple of the breast and the darker area (the areola) around it.

Although federal legislation makes breast reconstruction a required part of all health insurance policies, only about 30 percent of female breast cancer patients opt for it. The low number may be attributed to one simple fact: Women may not know that reconstructive surgery is an option.

Indeed, a 2009 study found that nearly a whopping 70 percent of women who are eligible for breast reconstruction are not informed of their options. And there are options.

In 1998, the government passed the Women’s Health and Cancer Rights Act (WHCRA). The act requires that health insurers who offer mastectomy coverage also provide coverage for related services. The coverage includes all stages of breast reconstruction and surgery and reconstruction of the opposite breast.

In addition, the act didn’t limit breast reconstruction to just cancer patients. It also stipulated that a mastectomy performed for any reason warrants coverage.

But many women aren’t offered this information. As a result, they miss the opportunity to undergo a surgery that can improve their physical and psychological outlooks and help restore their lives.

“We have to communicate more,” says Nia Banks, MD, PhD, a plastic surgeon at Doctors Community Hospital in Lanham, Maryland. “Women should know that reconstruction and all things related will be covered by their insurance.”

Banks believes that doctors should discuss breast reconstruction surgery with their patients when a woman is informed she has breast cancer.

“Ideally, the plastic surgeon is part of your team,” Banks says. “Even if a woman decides not to have reconstructive surgery or decides to delay it, it’s helpful to talk to a surgeon. It’s good to have the information.”

When doctors provide this information to patients, it educates them about the breast reconstruction process, which can be lengthy. It’s also a way to help patients know their options so they may best prepare for any eventuality.

Patients must consider whether or not they want breast reconstructive surgery, what kind they want, and when to do it.

If a woman decides to have immediate reconstruction, the doctor begins the process of rebuilding the breast during the patient’s breast removal surgery. Some women choose to delay their surgery for months or even years in order to recover or receive radiation treatment. Some opt out for personal reasons, such as not wanting additional surgery, fearfulness that their cancer will return and concern about how the reconstructed breast will look.

According to Banks, doctors now view immediate reconstruction as the best option. Women who start reconstruction at the same time as their mastectomy are able to minimize the number of surgeries and are more likely to have a better mental outlook. Plus, docs can more easily see where the natural folds of the breast fall. This produces better breast reconstruction results.

“We would like to capture more women with immediate reconstruction,” Banks says. “It hasn’t always been the standard of care, but that’s now changed. We’re realizing the importance of [quickly] restoring that woman back to total health.”

There are two types of breast reconstruction procedures. One uses expanded tissue at the site to cover the implant, and the other uses a flap of tissue from another part of the body to cover the implant.

When a woman opts for breast implant surgery, during her mastectomy, a plastic surgeon creates a pocket in her chest to hold an implant. The doctor then places either a saline or silicone implant or a tissue expander (a balloon containing salt water) in the breast pocket. (After several years of scientific study, the U.S. Food and Drug Administration (FDA) approved silicone gel-filled breast implants for breast reconstruction in women of all ages and breast augmentation in women ages 22 and older.)

Tissue expanders are used if your skin and chest wall tissues are tight and flat. Docs place the tissue expander under the skin and chest muscle to stretch the skin and prepare the location to receive the implant at a later date. (The recovery time for a tissue expander procedure is two to three weeks.)

For tissue flap surgery, doctors take tissue from the stomach, back, thighs or buttocks to rebuild the breast. This surgery uses women’s own skin and fat and leaves scars at two surgical sites: the location from where docs remove the tissue and the place where they put it. (The recovery time is almost six weeks.)

Usually, both types of procedures are completed in three stages. First, docs build the breast mound. Second, surgeons reconstruct the nipple (and remove the tissue expander if one was used). And finally, docs tattoo the areola, a procedure that matches the color of the reconstructed breast’s nipple areola  to the natural color of the nipple areola of the woman’s opposite breast. (The procedure usually happens in the doctor’s office.)

In general, the type of reconstruction performed depends on whether breast cancer patients need chemotherapy or radiation after breast cancer treatment, and if they have other medical problems or histories.

“If they have medical problems or if we’re concerned about post operation complications, we recommend the simplest breast reconstruction procedure—the tissue expander procedure—so patients can get on with their treatment,” Banks says. “The tissue flap procedure requires a second surgical site and a longer recovery time because there are more wounds to heal and [the possibility of] more complications.”

DiCocco opted for the tissue expander surgery. After her operation, she went through eight rounds of chemotherapy and took intravenous chemo agents for one year. Once that was completed, she exchanged her expanders for silicone implants.

“I was 26 years old,” Jennifer says. “I wanted to look as normal as I could in clothes. I was happy with my body before cancer and wanted to get back to the same size and shape.”

While women mourn breast loss and struggle with reconstruction adjustments (lost sensation and the accompanying emotional and physical scars), Banks notes that many patients find taking control of their appearance is a positive and empowering moment for them, and a helpful part of their recovery process.

Because she’d treated breast cancer patients and performed mastectomies as part of her work, DiCocco was aware of her options. But many women aren’t.

In some parts of the country, female breast cancer patients older than 40 are 48 to 93 percent less likely (depending on the age group) to undergo surgery. African-American women are also less than half as likely as white women to undergo breast reconstruction, and women with private insurance are nearly eight times as likely to have the procedure as women with Medicaid.

But Banks says ignorance is the biggest barrier to women opting for reconstructive surgery. “Patients have to deal with whether or not there is a plastic surgeon available and if they take health insurance,” Banks says. “But the bigger issue is that patients are uninformed because we’re not enlightening them. Women should know that breast reconstruction is always an option—even after 15, 20 or 30 years have passed.”

For DiCocco, there was no such time lag and breast reconstruction proved a key part of her cancer recovery. She also credits her return to normalcy to having supportive friends and family, good doctors and effective nausea-fighting drugs (to help with chemotherapy side effects).

“Reconstruction won’t give you back your real breasts; they are different,” DiCocco says. “You’ll always have the scars to prove what happened. But for me, reconstruction helped me look like myself again.”