Breast Reconstruction Surgery

Implant-based breast reconstruction is the most common type of reconstruction performed in the United States. It requires the use of a silicone or saline implant and may require the use of additional materials to support or fully cover the implant.

2-stage implant

This type of reconstruction requires two procedures: one to place a tissue expander (a balloon-like device with a metal port), and a later one to insert the implant. The tissue expanders allow the skin and muscle to stretch through a balloon-like device that is filled once a week with saline. It can take one to three months to fill the expander to the desired size.

Some patients will need additional material, such as human cadaver skin, to cover part or all of the tissue expander.

Once you have completed tissue expander fills, a surgeon will remove the tissue expander and place the permanent implant. You will not need to stay overnight in the hospital and typically can return to work four to seven days later.

Recommended if you:

• Do not have enough abdominal tissue or fat elsewhere to cover the implant
• Want both sides reconstructed

Not recommended if you:

• Are obese
• Are unable to attend six to eight weekly visits for drain expansion
• Smoke
• Want the most natural-looking breasts

Direct to implant

Only a few women are candidates for this type of reconstruction. This procedure eliminates the need for tissue expansion and a second procedure. It’s likely you’ll need additional material such as human cadaver skin to cover part of the implant.

Recommended if you:

• Are having nipple-sparing mastectomy
• Do not have enough abdominal tissue or fat elsewhere to cover the implant
• Have smaller breasts with little to no droop
• Want both sides reconstructed

Not recommended if you:

• Can’t have nipple-sparing mastectomy
• Don’t want a mesh or human cadaver skin used
• Have large breasts with lots of droop
• Smoke
• Want the most natural-looking breasts

This type of reconstruction moves tissue from the abdomen or thighs to the chest. Flap reconstruction typically is used for patients who have a history of radiation, want their reconstructed breast to match their unaffected breast, or do not want an implant.

TRAM (Pericle) flap

This procedure uses skin, fat, and the rectus muscle (six-pack muscle) from the lower abdomen to reconstruct a breast mound. It’s left attached to its base and tunneled under the skin to the chest. This reconstruction may require three surgeries: one to place clips on blood vessels to increase blood supply to the muscle, one to create the breast mound, and one for nipple reconstruction.

Recommended if you:

• Are healthy enough for a long surgery
• Have had radiation in the past
• Have enough abdominal tissue to transplant
• Want to use your own body tissue

Not recommended if you:

• Are on narcotics for chronic pain
• Have had abdominal surgery (not including C-section or laparoscopic surgery)
• Smoke

DIEP (deep inferior epigastric artery perforator) flap

This type of flap procedure also is known as muscle-sparing free TRAM. It uses fat and skin from the lower abdomen but very little to no muscle (about a postage stamp-sized amount). This reconstructive procedure will require two surgeries: one for creation of the breast mound and one for nipple reconstruction.

Recommended if you:

• Have had radiation in the past
• Have enough abdominal tissue to transplant
• Want to use your own body tissue

Not recommended if you:

• Are on narcotics for chronic pain
• Have a history of blood clotting disorders
• Smoke

TUG (transverse upper gracilis) flap

This type of flap reconstruction uses muscle from the inner thigh and may be used when the abdomen cannot be used as a tissue donation site. This procedure will require two surgeries: creation of the breast mound and nipple reconstruction.

Recommended if you:

• Do not have enough abdominal tissue to transplant
• Have had a previous tummy tuck or TRAM
• Have had radiation in the past
• Want natural-looking breasts

Not recommended if you:

• Are on narcotics for chronic pain
• Smoke

This procedure may be used if you have had a failed flap procedure; if you are not a candidate to use your abdomen or thighs for tissue donation; or if you have very large breasts that can benefit from the added volume of a latissimus flap.

Latissimus dorsi flap

In this procedure, the surgeon rotates the latissimus dorsi muscle (one of the largest muscles in the back) to your chest. After it’s rotated, the surgeon will place a tissue expander underneath it. The expander will be filled with saline weekly until the breast is the desired size, at which time it will be exchanged for an implant.

Recommended if you:

• Don’t have enough tissue to transplant from your abdomen or thighs
• Have a larger body frame and want larger breasts
• Have had radiation in the past

Not recommended if you:

• Are unable to come to four to eight weekly visits for drain expansion
• Smoke
• Want the most natural-looking breasts

Oncoplastic reconstruction refers to breast reconstruction that is performed immediately after a lumpectomy, or surgery to remove the portion of the breast containing cancer. This reconstruction is done using breast lift or breast reduction techniques. We’ll also perform a symmetry procedure on the healthy breast to make them look the same.

Recommended if you:

• Have large breasts and need a large amount of breast tissue removed
• Want smaller, lifted breasts that will be symmetrical

Not recommended if you:

• Don’t want more than one scar on your breast
• Don’t want your breast size reduced
• Have smaller breasts
• Have cancer in multiple areas of the breast
• Have cancer behind the nipple
• Smoke

While we can’t yet perform these procedures, they are what’s next in breast reconstruction.

Fat grafting refers to harvesting fat from another part of the body and injecting it into the breast. By doing this, surgeons will be able to add volume, fill a dimple or groove, or correct a contour deformity in the breast.

Surgeons have yet to figure out how to recreate a nipple that functions the way it’s supposed to. We hope in the future to be able to restore nipple function and sensation.

We're here to provide the answers you need.

How does breast reconstruction surgery work?

Breast reconstruction surgery rebuilds the breast mound using an artificial implant and muscle, skin, or fat from other areas of your body. Your reconstruction surgery will depend on the type of surgery you had and how much of the breast needs reconstruction.

It’s important to understand that sensation in the breast or nipple may not be the same as it was before surgery.

Will I have scars after plastic surgery?

Surgery always leaves a scar, but everyone heals differently. Your scars may be more or less noticeable than others’. Although we can’t eliminate scarring, there are strategies we can use to limit it.

Will my breasts match after surgery?

If both breasts undergo reconstruction, it’s often easy to match them. If only one breast is reconstructed, it’s more difficult. In many cases, your other breast can be modified with a breast lift, reduction, or augmentation, to achieve symmetry. Some insurance plans cover this procedure.

What questions should I ask before breast cancer surgery and reconstruction?

• What do I want my breasts to look like after I’m done with treatment?
• Is delayed breast reconstruction an option?
• Do I need to make a decision about reconstruction right away?
• What will life be like for me without reconstruction?
• Am I a candidate for breast conservation?
• What reconstruction options fit best with my overall treatment plan?

What happens after breast reconstruction surgery?

While recovering from breast reconstruction surgery, be aware of the following:

• You may be mildly groggy and dizzy due to the anesthesia.
• We recommend you take your prescription pain medication as advised before your discomfort becomes severe. For less severe pain, you can take acetaminophen or any non-aspirin pain reliever.
• You may not want to use the arm on the side of your mastectomy for blood pressure tests, IVs, or blood draws. Discuss this with your surgeon.

Some personal care tips to keep in mind:

• Keep the dressing clean and dry. You many need to sponge bathe. Don’t remove the dressing unless directed to do so by the doctor.
• A drain may be needed to remove blood and fluid from the surgery site. As the container fills with fluid, you will need to empty it. The doctor or nurse will show you how to do this.

Talk with your doctor about when to start post-op exercises. Avoid activities that involve:

• Heavy lifting (more than 10 pounds)
• Overhead arm movement, such as reaching and stretching
• Repetitive arm movement, such as vacuuming and raking

What kinds of symptoms indicate there may be a problem after surgery?

Call your doctor immediately or go to the emergency room if you develop any unusual symptoms after breast reconstruction surgery, such as:

• Bleeding (more than a stain on the dressing)
• Pus-like discharge
• Redness or discoloration of the skin
• Severe pain not lessened by pain medication
• Shaking chills and/or fever over 101 degrees Fahrenheit
• Swelling

Is it ever too late to have breast reconstruction surgery?

No, it is never too late as long as you are healthy. Discuss the risks and benefits of postponing breast reconstruction with a board-certified surgeon.