Breast Reconstructive Surgery

Considering breast reconstructive surgery after a mastectomy or lumpectomy? Breast reconstructive surgery can improve self-esteem and confidence and give you a natural silhouette.

It’s important to gather the facts you need to make a good decision about breast reconstructive surgery. This page will discuss the reasons women undergo breast reconstructive surgery, what types of procedures are available and the benefits and risks of breast reconstructive surgery procedures.

Breast Reconstructive Surgery Procedures

There are two types of breast reconstructive surgery procedures: breast implants or flap breast reconstructive surgery using grafted tissues. In some procedures, a flap reconstructive surgery is combined with implants.

The best way to determine whether or not breast reconstructive surgery is for you or what procedure to pursue is to schedule a consultation with a breast reconstructive surgery expert. You can find a skilled surgeon near you by using our Surgeon Locator.

If you are having a mastectomy, you may be able to have your breast reconstructive surgery simultaneously. However, some women choose to wait so they can take more time to make a decision about breast reconstructive surgery. In some cases, a woman has to wait for breast reconstructive surgery until after chemotherapy on the chest is completed.

Find a Breast Reconstructive Surgery Expert

Finding the right surgeon can make all the difference in your breast reconstructive surgery experience. We work hard to connect you with the best doctors in your area. Our physicians are skilled and qualified in cutting-edge reconstructive surgery techniques. They perform surgery in accredited medical facilities, keep abreast of the latest developments in their field, complete continuing education in reconstructive surgery and follow the highest standards in patient care and safety.

Click on “Surgeon Locator” to search our physician directory for a surgeon in your region. You can read about physicians’ credentials, visit their websites, learn about the reconstructive surgery procedures they perform and see pictures of their offices and patients.

The first step toward your breast reconstructive surgery is setting up a consultation with a surgeon. During your consultation, your doctor will gather information about your medical history and ask you questions about your goals in pursuing reconstructive surgery. He or she will determine whether or not you are a candidate for breast cancer reconstructive surgery and which procedure will work best for your situation and produce the best results.

The only way to know for certain if you are a candidate for breast reconstructive surgery is to meet with a qualified surgeon.

The goal of reconstructive surgery is to improve your appearance, your sense of well-being and your life. We encourage you to take this important step by searching for a local doctor today.

Breast Reconstructive Surgery After Mastectomy

Breast reconstructive surgery after mastectomy restores a natural silhouette for a woman who has had one or both breasts removed due to breast cancer. Different techniques exist for reconstructing breasts, and the technique that’s right for you depends on your body type, the extent of your cancer, the desired size of the reconstructed breasts and other factors.

Not all women who have a mastectomy choose to have breast reconstructive surgery. However, many women find that breast reconstructive surgery improves their self-esteem and confidence.

Breast Reconstructive Surgery After Lumpectomy

Some women may be treated for breast cancer without removal of the entire breast. A lumpectomy—or the removal of only some of the breast tissue—may require breast reconstructive surgery to restore the breast to its full volume.

Breast Reduction Surgery

Women with large breasts may experience back problems and other medical problems, especially women who have a small frame. A breast reduction can relieve problems associated with large cup sizes. In some cases, men may also receive breast reduction for abnormally large male breasts.

Am I a Candidate for Breast Reconstructive Surgery?

You are likely a candidate for breast reconstructive surgery if you have had a mastectomy or will be having a mastectomy, or if you need a breast reduction due to back pain or other problems. Only your surgeon can determine for sure whether or not you are a candidate for breast reconstructive surgery.

Your doctor will be able to discuss breast reconstructive surgery options with you, including flap breast reconstructive surgery and implants. To determine candidacy, your doctor will take a detailed medical history and perform an examination. Some women may not be candidates for breast reconstructive surgery, such as heavy smokers or women with additional medical problems.

Breast Reconstructive Surgery Using Implants

Many women opt for breast implants. Breast reconstructive surgery using implants may involve either a one-step or two-step approach. In the one-step approach, the implants are inserted underneath the skin and chest muscle. In the two-step approach, a tissue expander is inserted first, and the doctor slowly fills it with a saline solution over the course of several months to expand the area and prepare it for the implant. Next, the expander is removed and the implant is inserted.

Even if a woman needs to have chemotherapy before her breast reconstructive surgery, tissue expanders may be inserted and filled during the time she is receiving chemotherapy.

Implants come in two varieties: saline-filled implants and silicone gel-filled implants. Although silicone implants were banned in the United States in the early 1990s, the FDA recently approved the new generation of silicone implants due to research showing they are safe. Whether saline or silicone implants are right for you will depend on your body shape and other factors. Each type has benefits that your doctor will be able to discuss with you.

Breast reconstructive surgery using implants is a safe and effective method and is the most common breast reconstructive surgery method used around the world. A benefit of implants over flap reconstructive surgery is that receiving implants only results in one surgical site.

However, drawbacks include:

• Implants may not last forever; you will probably have to replace them at some point in the future
• Implants can leak, rupture or cause pain
• Implants can lead to capsular contracture, a condition in which the tissue around the implant hardens

Breast Reconstructive Surgery Using Flap Techniques

Flap breast reconstructive surgery uses tissue from a woman’s own body to reconstruct the breast after a mastectomy. Tissues are often taken from the abdomen, back or buttocks. In most cases, a muscle is grafted, although some techniques reconstruct the breast from fat and skin and do not use muscle. Because flap reconstructive surgery uses a woman’s own body tissues, it can create a more natural-looking breast than implants alone.

Flap breast reconstructive surgery is performed in a hospital or surgical center and can take up to seven hours, depending on which procedure is used and whether the woman is having a unilateral reconstructive surgery (one breast) or bilateral reconstructive surgery (both breasts). Some procedures take as little as one or two hours. The hospital stay may be one to five days.

This type of reconstructive surgery results in two scars—one at the donor tissue site, such as the abdomen or back, and one on the breast. In some cases, implants may be used in conjunction with flap breast reconstructive surgery, but many times the grafted muscle and tissue are enough to reconstruct the breasts without the use of implants.

There are two major methods of flap breast reconstructive surgery. In the “pedicle” method, the muscle and tissue are removed and implanted while still attached to their original blood supply. In this type of flap breast reconstructive surgery, the muscle’s blood vessels are left intact and the muscle is tunneled under the skin and pulled through to the chest.

In a “free” flap reconstructive surgery, the muscle is removed from its original blood supply and the blood vessels are cut. The surgeon then attaches the muscle’s blood vessels to blood vessels in the chest, to restore a blood supply. This intricate surgery is called microsurgery. Although a free flap reconstructive surgery has many benefits, it is more difficult to perform and therefore is less common.

Common flap breast reconstructive surgery techniques include the TRAM flap, free TRAM flap, latisimus dorsi flap, and DIEP flap. However, some doctors also perform other flap techniques. You should discuss with your doctor the various procedures available to help determine which technique is right for you.

Drawbacks of flap reconstructive surgery include:

• The technique involves two surgical sites—the chest and the donor site
• Possible muscle weakening at the donor site
• Possible hernia if your doctor uses a muscle from your abdomen

TRAM Flap Breast Reconstructive Surgery

TRAM flap is the most widely used flap breast reconstructive surgery technique and is considered the standard of care today. TRAM stands for “transverse rectus abdominis muscle” and uses tissues from your abdomen to reconstruct your breasts.

This procedure can actually give you a slimmer figure, as the tissue removed from the abdomen is the same tissue removed during a cosmetic tummy tuck procedure.

For a TRAM flap breast reconstructive surgery, the surgeon removes the rectus abdominis muscle, along with a large patch of skin and fat from the abdomen. With its blood vessels still attached, this muscle is tunneled under the skin to the chest wall. The surgeon then positions the muscle and forms a breast mound out of the muscle and fat.

To perform a “free” TRAM flap breast reconstructive surgery, the surgeon removes the muscle and tissues and cuts the blood vessels. When the muscle and tissues are moved to the chest, the surgeon creates a new blood supply by attaching the tissues to vessels in the chest using microsurgery. The free TRAM method may result in a healthier flap due to a stronger blood supply. However, the procedure is more difficult to perform, so the pedicle method is more commonly used.

The TRAM flap method may not be a good choice for all women. For example, women who have previously had an abdominal surgery or who are already quite thin may benefit more from a procedure that uses tissues from another part of the body. Your doctor can help you decide which flap breast reconstructive surgery method is right for your body and your situation.

To reduce the risk of hernia after a TRAM flap procedure, the surgeon may place a surgical mesh over the affected area.

A TRAM flap reconstructive surgery leaves a scar from hip to hip where the muscle, fat and skin have been removed. However, the scar is low and will be hidden underneath the woman’s underwear.

Latissimus Dorsi Flap Breast Reconstructive Surgery

In this procedure, the latissimus dorsi muscle is used. This muscle is located on the side of the back, underneath the arm. The surgeon removes the muscle while leaving the blood vessels attached. Next, the surgeon tunnels the muscle through the back and under the skin to place it in the chest.

The latissimus dorsi flap method is often used to provide soft tissue over implants, to create a more natural look and feel. However, for women with small breast sizes, this technique can be used without the need for implants. After this procedure, the patient will have a scar on the midback, toward the side of the body.

DIEP Flap Breast Reconstructive Surgery

The DIEP flap procedure is a newer development that does not require the removal of muscle. Using tissues from the same area as the TRAM flap technique, the DIEP flap procedure allows the patient to benefit from the “tummy tuck” effect of removing tissues from the abdomen without the need to remove muscle.

DIEP stands for deep inferior epigastric perforator, which refers to an artery in the abdomen. Skin and fat are removed along with this artery and are moved to the chest to form a breast mound. The artery is removed by cutting into the muscle, but the muscle itself is left intact.

Benefits of the DIEP flap procedure include:

• No risk of losing muscle strength in the abdomen because no muscle is removed
• Reduces the risk of hernia that comes with the TRAM flap procedure
• Quicker recovery because the surgery does not remove muscle
• Shorter hospital stay

Although DIEP flap breast reconstructive surgery has many benefits over other procedures, it requires microsurgery and is more difficult to perform than a traditional TRAM flap surgery. Because fewer surgeons are qualified to perform DIEP flap breast reconstructive surgery, it has not yet gained the popularity of other procedures.

Additional Procedures After Your Breast Reconstructive Surgery

After your initial surgery, you may require additional procedures to complete your breast reconstructive surgery. Your surgeon may perform procedures to further shape and contour the reconstructed breast to achieve the desired shape and size.

For a unilateral breast reconstructive surgery (only one breast was removed), the surgeon will try to match the natural breast to the reconstructed breast. This may require a breast lift or other procedure on the natural breast.

Nipple creation can take place once the initial breast reconstructive surgery is completed and your reconstructed breasts have healed. Several options exist for nipple and areola reconstruction, including using local tissue flaps, skin grafts and tattooing. Your surgeon can go over these options with you. Some women are comfortable without a nipple and opt out of this step of breast reconstructive surgery.

Will Insurance Cover My Breast Reconstructive Surgery?

If your insurance plan is covering your mastectomy, the law actually requires your insurance company to also cover breast reconstructive surgery. In the United States, the Women’s Health and Cancer Rights Act was signed into law in 1998. Because of the positive psychological benefits of breast reconstructive surgery after mastectomy, this law requires insurance coverage for breast reconstructive surgery, including procedures performed on the opposite breast to improve symmetry.

If your breast reconstructive surgery is not due to mastectomy or lumpectomy, your insurance may still cover your procedure if it is deemed medically necessary. You should contact a representative of your insurance company to discuss whether or not your procedure will be covered and what copays and other costs you will be responsible for.

If you do not have insurance, you should still meet with a breast reconstructive surgeon to discuss your options.

Breast Reconstructive Surgery Risks

As with any surgical procedure, breast reconstructive surgery is not without risk. Risks that come with any surgery include:

• Risks of anesthesia, including allergic reactions
• Bleeding
• Infection

Risks of breast reconstructive surgery using implants include:

• Implants may not last forever; you will probably have to replace them at some point in the future
• Implants can leak, rupture, or cause pain
• They can lead to capsular contracture, a condition in which the tissue around the implant hardens

Risks of flap breast reconstructive surgery include:

• The technique involves two surgical sites—the chest and the donor site
• Possible muscle weakening at the donor site
• Possible hernia if your doctor uses a muscle from your abdomen

Should I Have Immediate or Delayed Breast Reconstructive Surgery?

Breast reconstructive surgery can be performed simultaneously with a mastectomy. However, you may elect to have your breast reconstructive surgery later if you choose. In some cases, it may be necessary to delay your breast reconstructive surgery, depending on the stage of your cancer and the cancer treatments you will be receiving.

Don’t worry if you need to delay your breast reconstructive surgery; you can still experience a successful breast reconstructive surgery if you elect to wait. In fact, many women choose not to reconstruct their breasts, only to decide years later to get a breast reconstructive surgery. The decision to opt for a breast reconstructive surgery is a personal one, and you must give yourself the time you need to make the right choice.

Before Breast Reconstructive Surgery

Before your surgery, you should discuss with your doctor any drugs you take, including non-prescription drugs and supplements. It’s important that you are honest and upfront about your drug use, smoking habits and use of alcohol, as these substances may affect your recovery.

Your doctor will give you specific instructions regarding which medications you should stop temporarily and which you may continue taking. If you take maintenance drugs for a medical condition, such as heart disease or diabetes, you should discuss these medications and your upcoming surgery with the doctor who treats these conditions.

Your doctor will direct you to refrain from eating for a specified number of hours before your surgery and will give you further instructions to follow to prepare for your breast reconstructive surgery. It’s normal to be nervous before surgery. You must follow your doctor’s instructions carefully and be sure to ask him or her any questions you may have.

Before your surgery, you will undergo a thorough evaluation and tests will be run to reduce the risk of complication during surgery.

After Breast Reconstructive Surgery

Recovery from breast reconstructive surgery normally takes three to six weeks. Recovery from reconstructive surgery using implants may be quicker than recovery from flap breast reconstructive surgery.

Your doctor will give you instructions to follow when you return home, such as how to take care of your incisions. You must carefully follow these instructions. Your doctor will explain how long you must refrain from certain activities, such as strenuous exercise, and when you may return to work.

It’s normal to feel pain or discomfort after your surgery. Your doctor will let you know which over-the-counter medications to take to effectively treat your post-surgery pain. He or she may also prescribe a stronger pain medication if necessary.

Some pain and swelling may be normal. However, you should call your doctor if you experience abnormal symptoms or severe pain. Discuss with your doctor which symptoms are normal and to be expected and which are unusual and require medical attention.

Your breast reconstructive surgery may require additional procedures, such as nipple reconstructive surgery or a revision to improve breast symmetry.

Breast Reconstructive Surgery Results and Limitations

The positive psychological benefits of breast reconstructive surgery are often substantial, and having breasts that give a natural silhouette can provide confidence and improve self-esteem.

While breast reconstructive surgery is not risk-free, serious complications are not common. Most women are happy with the results of their breast reconstructive surgery. However, you must have realistic expectations before your surgery. No breast reconstructive surgery can give you back your breasts; a reconstructed breast will not feel exactly the same as a natural breast.

Before your surgery, you should discuss your goals and expectations with your doctor. You can also benefit by seeking out other breast reconstructive surgery patients and reading case studies online. Ask your doctor to show you before-and-after photos to give you a realistic idea of what breast reconstructive surgery procedures are capable of.