About Breast Reconstruction

What is breast reconstruction?

Women generally have mastectomies for two reasons: a therapeutic mastectomy to treat breast cancer or a prophylactic mastectomy to prevent it.

Most women who have mastectomies are eligible for breast reconstruction, which is a surgery to rebuild the breasts. Breast reconstruction can be done with or without breast implants.

The decision to undergo breast reconstruction is a very personal one, and not every woman chooses to have breast reconstruction. If you decide to undergo breast reconstruction surgery, it is important you understand the risks and benefits, and have realistic expectations of the outcome of your surgery so that you can be comfortable and confident with your decision. One of your most important resources through this process is your plastic surgeon, the doctor who will perform the breast reconstruction surgery. He or she will be able to explain the benefits and potential risks associated with breast reconstruction, and what approach may be best for you.

Breast surgery can greatly change the shape and appearance of a woman’s breast. When a woman has a mastectomy, whether therapeutic or prophylactic, all the breast tissue and some of the skin, including the nipple and areola, may be removed. For some women, a newer technique, called a “nipple-sparing mastectomy” may be an option. The remaining tissue and skin may be more sensitive because of the surgery, chemotherapy, and/or radiation treatments.

What are my breast reconstruction options?

There are two main options for breast reconstruction: 1) reconstruction using sections of your own tissue, a “flap” and 2) reconstruction using a breast implant.

Option 1: Tissue Flap

Reconstruction using your own tissue involves transferring tissue (muscle, fat, skin) from another area of your body (e.g. stomach, back, thigh) and shaping it into a new breast. The tissue flap can be separated from its original blood vessels and moved to its new place on your chest. This is frequently referred to as a “free flap.” Alternatively, the tissue can remain attached to its original blood vessels and moved under your skin to your chest. This is often referred to as a “pedicled flap.” With both types of flap procedures, the tissue is formed into the shape of the breast and stitched into place.

Option 2: Breast Implant

The most common type of reconstruction surgery with breast implants is two-stage reconstruction in which a tissue expander is used. During your mastectomy, breast tissue and some skin will be removed, leaving your chest flatter and tighter. For many women, there will not be enough skin and tissue to cover the implant, so a tissue expander is implanted during the first stage of the procedure to create space for the breast implant.

A tissue expander is a temporary balloon-like device. The expander is gradually filled over time with carbon dioxide or saline, depending on the type you receive. The expansion will cause your breast skin and tissue to gradually stretch similar to how a woman’s stomach stretches during pregnancy. The stretching creates a space, called a “pocket”, for the breast implant. At the second stage procedure the tissue expander is removed and replaced it with a breast implant.

Determining which approach is right for you will depend on certain factors, including:

It’s important to know that while breast reconstruction rebuilds the breast, it won’t look exactly the same as before the mastectomy. Talk to your surgeon so you are well-informed and prepared to decide the best option for you.

What is the best timing for breast reconstruction?

If you decide to move forward with breast reconstruction, you can choose to have immediate or delayed reconstruction. Immediate reconstruction begins at the time of your mastectomy. Delayed reconstruction may begin months or years after your mastectomy. The timing of your breast reconstruction surgery should be a thoughtful decision you make together with your surgeon.