Breast Reconstruction

The right approach will depend on your anatomy, cancer treatment plan and personal preference. Our highly skilled surgeons perform the following breast reconstruction and restoration procedures:

Implant-Based Reconstruction

Implant-based reconstruction uses a saline or silicone implant to rebuild the breast and is the most common approach to breast reconstruction. In many cases, a tissue expander is placed first to gradually stretch the chest muscle and skin, followed by a second surgery to place the permanent implant, often filled with a cohesive silicone gel. Some patients are candidates for direct-to-implant reconstruction, skipping the expander step. Patients choosing this option should know that with any breast implant, there is a small risk of capsular contracture, which is a tightening of the scar tissue around the implant, as well as a very minimal risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

Nipple-Sparing Mastectomy With Immediate Reconstruction

This procedure involves preserving the skin of the breast and nipple. Reconstruction often takes place during the mastectomy or immediately afterward. This approach offers aesthetic benefits, helping women maintain a more natural breast appearance.

Nipple and Areola Reconstruction

Nipple reconstruction rebuilds the nipple and areola after mastectomy, usually as a final step once the breast mound has healed from earlier surgery. This can be done surgically, via skin grafts or local tissue flaps. 3D areola tattooing is sometimes used for a more natural appearance. This type of reconstruction may be needed if nipple-sparing mastectomy is not an option.

Delayed Reconstruction

This approach offers the option of undergoing breast reconstruction at a later stage, following the primary mastectomy. Delayed reconstruction is particularly beneficial for those requiring additional treatments, such as radiation or chemotherapy before reconstruction.

Restoration

Restoration surgery involves a microsurgical technique to reconnect nerves in the breast area. This significantly increases the chance of regaining normal breast sensation. Restoration is aimed at patients who have lost sensation due to mastectomy or other breast surgeries. 

Autologous (Flap) Reconstruction

Commonly called “flap reconstruction,” autologous tissue reconstruction uses  uses tissue from your own body, such as from the abdomen, back or thighs, to recreate the breast. This technique, known for its natural look and feel, is a preferred choice for those seeking a more organic reconstruction option. A flap procedure not only allows for the creation of a breast that closely matches the original in shape and texture, but also offers the benefit of tissue that ages more naturally. Depending on where the tissue comes from, and whether its blood supply is fully disconnected and microsurgically reconnected (free flap) or left attached and tunneled into place (pedicled flap), options include:

• Deep inferior epigastric perforator (DIEP) flap: This uses skin and fat from the lower abdomen while preserving the chest muscle.
• TRAM flap: A transverse rectus abdominis myocutaneous flap uses abdominal tissue along with a portion of the chest muscle.
• Profunda artery perforator (PAP) flap: This uses tissue from the inner thigh.
• Superficial inferior epigastric artery flap: The SIEA flap uses abdominal tissue through small vessels near the skin’s surface.
• Transverse upper gracilis flap: The TUG flap uses tissue from the upper thigh

Going Flat

Not every patient will choose breast reconstruction. Going flat, completing the mastectomy without rebuilding the breast mound, is a very personal choice. Patients who “go flat” may choose an external breast prosthesis for clothing fit, or no prosthesis at all. Our team supports whichever path fits your body image and your lifestyle.

How Does Breast Reconstruction Surgery Work?

Breast reconstruction is performed under general anesthesia, either at the same time as a mastectomy or lumpectomy (immediate reconstruction) or as a separate operation down the road (delayed reconstruction). For implant-based reconstruction, the surgeon places a tissue expander or implant beneath or over the chest muscle to restore breast volume. For flap reconstruction, the surgeon removes tissue from the donor site and shapes it into a breast mound, using microsurgery to reconnect blood vessels when the tissue is fully detached. 

Reconstruction may require more than one surgery. A second procedure may be recommended to address symmetry on the opposite breast, nipple and areola reconstruction or minor revisions to achieve the desired shape.

Breast Reconstruction Success Rates

Breast reconstruction has strong, well-documented outcomes for most patients, and satisfaction tends to be highest when the procedure is performed by experienced surgical teams. The American Society of Plastic Surgeons notes that both implant-based and autologous reconstruction offer high patient satisfaction, with autologous procedures generally rating the highest. Studies find that when it comes to breast cancer recurrence after reconstruction, the likelihood was statistically very low for both implant-based and tissue-based surgeries.

Breast reconstruction is most often considered after a mastectomy or lumpectomy for breast cancer, though patients pursue it for other reasons as well.

Breast Cancer Surgery

Most reconstruction patients have had a mastectomy (removal of the entire breast) or a lumpectomy (removal of a tumor and surrounding tissue) as part of their breast cancer treatment. Reconstruction can restore breast shape and volume lost during breast cancer surgery.

Prophylactic Mastectomy

Patients who carry the BRCA1 or BRCA2 gene mutation, with or without a breast cancer diagnosis, may choose a prophylactic or risk-reducing double mastectomy to lower their chances of developing breast cancer, followed by reconstruction.

Who Qualifies for Breast Reconstruction?

Most breast cancer patients are candidates for reconstruction, whether performed immediately or on a delayed schedule. Patients with a BRCA1 or BRCA2 mutation may also qualify. Candidacy for a specific technique, implant-based versus autologous tissue, depends on factors like body type, prior surgeries, radiation history and whether the patient smokes.

As of 1998, breast reconstruction is protected under the Women’s Health and Cancer Rights Act (WHCRA), a federal bill that requires most insurers to cover reconstruction surgery and symmetry procedures on the unaffected breast. The WHCRA does not currently mandate coverage for prophylactic mastectomies, but if your risk-reducing procedure is already covered by your health insurance, the WHCRA means your reconstruction is likely to be covered as well.

Preparing for Breast Reconstruction

Your care team will walk you through what to expect before surgery. In general, preparation includes:

• Completing recommended imaging, including mammograms, and any pre-operative lab work
• Reviewing your breast cancer treatment timeline with your oncologist, surgeon and plastic surgeon so reconstruction is scheduled at the right time around your chemotherapy or radiation therapy
• Quitting smoking well in advance, since smoking significantly raises the risk of complications, especially with flap procedures
• Stopping blood-thinning medications as directed by your surgical team
• Arranging help at home for the first one to two weeks of recovery
• Confirming insurance coverage ahead of time

Recovering From Breast Reconstruction

Recovery varies by procedure type. Implant-based reconstruction typically allows patients to go home the same day or after a one-night hospital stay, while flap-based reconstruction usually requires a two-day hospital stay. This is because it involves microsurgery and needs a longer recovery for the donor site as well as the breast. 

Most patients can return to light activity or a desk job within two to four weeks, though full recovery, especially after a flap procedure, can take longer. Discomfort, swelling and temporary drains at the surgical site are common and are managed with prescribed pain medication. A second procedure to address symmetry on the healthy breast is common. This may include a breast reduction, breast augmentation or a breast lift.

Your surgical team will schedule follow-up visits to monitor healing and address any concerns, including rare complications like infection or blood clots.