Breast Reconstruction

Breast reconstruction is a specialized surgical procedure designed to rebuild the breast mound following a mastectomy, which involves the complete removal of the breast, or a lumpectomy, which entails partial breast removal due to breast cancer or other breast-related conditions.

This surgery aims to restore the breast’s shape, size, and appearance, helping you regain a sense of normalcy and confidence. Through various techniques, your surgeon can create a natural-looking breast that harmonizes with your body (and, in some cases, an unaffected breast) while aligning with your personal preferences.

There are two main techniques that your surgeon may recommend.

Breast reconstruction with implants: After a mastectomy, your surgeon rebuilds your breast or breasts using a synthetic breast implant. These implants are silicone or saline-filled devices that mimic the natural feel and look of breast tissue. For some individuals, implants can be placed immediately, on the same day as the mastectomy. For others, the process may be delayed, requiring multiple surgeries.

For delayed reconstruction, a tissue expander is typically inserted on the same day as the mastectomy and eventually replaced with a breast implant. A tissue expander is similar to an implant but is initially deflated, before being gradually filled with fluid or gas until it reaches the desired size.

This method is used if the skin remaining after breast removal is fragile and needs to heal before being stretched. This may be especially important if you are receiving other treatments — like radiation therapy — or if you prefer larger-sized implants. Once the tissue expander is filled to the appropriate size, your plastic surgeon will exchange it for an implant during a second surgery.

Autologous reconstruction: After a mastectomy, your surgeon may recommend reconstructing your breasts using your own natural tissues (skin, fat, or muscle) taken from a different part of your body, such as your belly, thighs, or back. These techniques, like the DIEP flap or TRAM flap, offer a natural look and feel by using your own tissue, which can also improve long-term results and overall satisfaction.

This approach tends to result in fewer issues with rejection or complications compared to implants. Moreover, the reconstructed breast can adapt naturally with your body over time, offering a more consistent and aesthetically pleasing outcome. The main disadvantage of autologous reconstruction is the complexity of the procedure, which leads to a longer recovery and other potential complications. Also, some patients may not be suitable candidates due to medical conditions or insufficient donor tissue.

Breast reconstruction is a complex process. When done successfully, it can restore your silhouette, though you should not expect to recapture the exact look and feel of your natural breasts as they existed before. Because intricacies are involved, it is imperative to work with a surgeon who has extensive experience. During a consultation, be sure to review the surgeon’s previous work and discuss the benefits and risks of various techniques.

The success of breast reconstruction largely depends on the surgeon’s expertise. Plastic surgeons performing these procedures should have specialized training in reconstructive breast surgery, including microsurgery for autologous tissue transfer. Board certification and experience with a variety of reconstruction techniques are critical factors in selecting a surgeon.

Breast reconstruction using implants involves placing silicone or saline implants to recreate the breast shape, often beginning with the insertion of tissue expanders during the mastectomy to stretch the skin and muscle, followed by a secondary surgery to place the permanent implant.

In contrast, free tissue transfer, such as the TRAM or DIEP flap, involves harvesting tissue from the patient’s abdomen, back, or thighs and transplanting it to the chest area. This complex procedure requires microsurgery to reconnect blood vessels. Though more complicated, this technique provides a more natural look and feel.

Both techniques aim to restore the breast’s appearance, with implants offering a simpler and quicker solution, while free tissue transfer provides a more natural and integrated result but involves a longer, more intricate surgical process.

Alternatives to surgery include external breast prostheses or breast forms worn inside a bra, which offer a non-surgical solution but lack the permanence and natural integration of surgical methods.

Ensuring patient safety is paramount, requiring thorough preoperative evaluations and vigilant postoperative care to monitor for complications such as infection, implant issues, or flap failure. Patients must be well-informed about potential risks and the necessity of follow-up care. It is crucial that breast reconstruction techniques are tailored to individual needs and health conditions.

Before you go

During your consultation and preoperative visit — for breast reconstruction in anticipation of undergoing mastectomy or lumpectomy — your surgeon will assess your medical history, discuss your reconstruction options (implants or autologous tissue), and evaluate your overall health. They will explain the surgical procedures, potential risks, benefits, and recovery expectations.

This visit also includes discussing your aesthetic goals, taking measurements, and possibly ordering imaging studies. It is an opportunity to ask questions, address concerns, and ensure you are fully informed and comfortable with the planned reconstruction approach.

Most importantly, your plastic surgeon should collaborate closely with your cancer surgeon to develop the most effective treatment plan tailored to your needs. Their strong communication and teamwork will ensure a seamless and coordinated approach to your overall care.

During the procedure

On the day of surgery, you will meet both your oncologic surgeon and plastic surgeon for a final discussion to confirm the breast reconstruction surgical plan.

Breast reconstruction is performed under general anesthesia, ensuring you are pain-free during the procedure. If autologous tissue is used, both surgeons will work simultaneously – the oncologic surgeon performing the lumpectomy or mastectomy and the plastic surgeon obtaining tissue from another part of your body – to minimize anesthesia time. Once the lumpectomy or mastectomy is completed, the plastic surgeon will proceed with the reconstruction using either autologous tissue or a tissue expander. Regardless of the type of reconstruction, the incisions will be closed meticulously, most commonly using dissolvable sutures.

Breast Reconstruction Aftercare 

After surgery, you will have one or two temporary drains on each side that will remain until your first clinic visit. These drains — thin, flexible tubes — are placed under the skin to prevent the accumulation of blood or fluid.

It’s not uncommon to notice swelling and bruising. Pain is usually managed with over-the-counter and prescription pain medications, as needed. If you choose implant-based reconstruction, you will be able to go home the same day or the day after surgery. If you choose autologous reconstruction, a hospital stay of a few days will be required for close monitoring. During this time, free tissue transfer is closely monitored through regular checks on blood flow and tissue health to ensure successful integration and to prevent complications.

The healing process after breast reconstruction involves several weeks of recovery. Regular follow-up appointments with your plastic surgeon are essential to monitor your progress, address any complications, and ensure the reconstructed breast is healing properly. Your surgeon will provide specific instructions on wound care, activity restrictions, and signs to watch for, ensuring a smooth recovery and optimal outcome.