The goal of breast reconstruction is to restore one or both breasts to near normal shape, appearance, symmetry and size following mastectomy, lumpectomy or congenital deformities.
Breast reconstruction often involves multiple procedures performed in stages and can either begin at the time of mastectomy or be delayed until a later date.

Breast reconstruction generally falls into two categories: implant-based reconstruction or flap reconstruction. Implant reconstruction relies on breast implants to help form a new breast mound. Flap (or autologous) reconstruction uses the patient's own tissue from another part of the body to form a new breast.

If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size, shape and position of both breasts.

 Breast reconstruction with implants

Implant-based breast reconstruction may be possible if the mastectomy or radiation therapy have left sufficient tissue on the chest wall to cover and support a breast implant. For patients with insufficient tissue on the chest wall, or for those who don't desire implants, breast reconstruction will require a flap technique. The most common method of tissue reconstruction uses lower abdominal skin and fat to create a breast shape.

 Immediate breast reconstruction above the pectoral muscle

This procedure is performed in combination with the mastectomy and results in an immediate breast mound. After the mastectomy has been performed by the breast surgeon, the plastic surgeon will place the breast implant. With this procedure, recuperation may be more rapid because the muscle in the chest has not been elevated. Further, the breast implant itself is not influenced by the contraction of the muscle.

 Delayed breast reconstruction utilizing tissue expander

The initial portion of this procedure entails the breast surgeon performing a standard mastectomy and possible axillary dissection. Once these procedures have been performed, the plastic surgeon will form a pocket for the breast expander. There are two types of breast tissue expander ports. One, similar to a chemotherapy port, is placed separate from the tissue expander, usually along the rib cage. This will require a separate small incision for the port. The second type is a port that is contained within the expander itself. In both instances, the ports will be used to inflate the tissue expander over several visits with saline solution. The port is accessed with a small needle and saline is injected into the expander through the port site.
Tissue expansion usually occurs weekly according to patient tolerance. The volume of the tissue expanders commonly exceeds the weight of the mastectomy tissue. The length of time will vary from patient to patient. Once this is completed, a second outpatient procedure will be necessary to remove the tissue expander and place the permanent breast prosthesis.

Flap reconstruction

This procedure is performed as a secondary operation immediately during the mastectomy or delayed after radiation. Reconstruction uses the patient's own tissue (flaps) from another part of the body. These flaps include the Pedicled TRAM flap, the free TRAM flap, the deep inferior epigastric artery perforator flap or the superficial epigastric artery flap.

However the latissimus dorsi flap is more frequently used. This flap is released from the back, passed through a tunnel that is made underneath the axilla and into the anterior chest to fill the mastectomy defect site. The muscle is placed and sutured to the chest wall. An implant is then placed behind this flap and in front of the chest.

The latissimus flap is recommended for patients who have already had mastectomy and radiation. The use of radiation frequently limits the amount of implant surgery that can be performed. The secondary advantage of this flap is that it brings new blood flow and healthy skin to the radiated field. It is also recommended for patients who are very thin and have limited options for flap reconstruction.

Reconstructing the nipple and areola.

For women who are not candidates for nipple-sparing mastectomy, breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. Techniques usually involve folding skin to create the shape of a nipple followed by tattooing. 


Following breast reconstruction surgery for flap techniques and/or the insertion of a breast implant, gauze or bandages may be applied to incisions.
An elastic bandage or support bra will minimize swelling and support the reconstructed breast. A small, thin tube may be temporarily placed under the skin to drain any excess blood or fluid.