Breast Reconstruction Options

The story doesn’t have to end after treatment. There are many options for breast reconstruction to restore your body image, confidence and emotional well-being.

If you’re like many women who’ve had breast cancer, you may be considering breast reconstruction following a mastectomy.

The procedure, often performed in several stages, aims to recreate the breast’s shape and appearance to help improve body image, restore confidence and offer emotional healing if you’ve lost one or both breasts due to cancer.

“In many cases, women undergo reconstructive surgery in tandem with their mastectomy,” says Sean Devitt, MD, a plastic and reconstructive surgeon at Geisinger. “But patients can choose to have breast reconstruction at any time, as long as they are healthy enough — mentally and physically — for the surgery.”

Breast reconstruction following a mastectomy

There are two main types of breast reconstruction: implant and autologous (tissue-based).

“In rare cases, a combination of implant and autologous reconstruction may be recommended,” says Dr. Devitt. “For instance, if there’s significant tissue damage in the chest area due to radiation, there may not be enough tissue to support an implant alone.”

Many factors influence the type of reconstruction you may undergo, including your stage of cancer, health status, personal preferences and physical build. There is no right or wrong choice; the decision is tailored specifically toward what’s best for you.

Implant reconstruction

Implant reconstruction is typically performed in two stages. In the first stage, a temporary implant called a tissue expander is placed beneath the skin. The expander is slowly filled with saline for several months to prepare the breast pocket for the future implant.

Once the chest tissues have healed from the mastectomy, the expander is replaced with a silicone implant to recreate the breast’s shape and size.

“This method is often chosen by women who prefer a shorter recovery period and a less invasive procedure with fewer scars,” says Dr. Devitt. “Fortunately, there have been great strides in breast implant technology. They are softer and more naturally appearing and feeling than ever.”

Autologous breast reconstruction

Autologous breast reconstruction, also called tissue flap reconstruction, uses a woman’s own tissue to rebuild the breast. This tissue, called the flap, is often taken from the abdomen (DIEP flap or TRAM flap), back (latissimus dorsi flap) or buttocks (I-GAP flap or S-GAP flap).

A DIEP flap (deep inferior epigastric perforator flap) is one of the most common types of this procedure. During a DIEP, fat, skin and blood vessels are removed from the tummy area and relocated to the chest. The blood vessels are then rejoined, and the tissue is reshaped into a breast.

This method typically provides a more natural look and feel to the reconstructed breast than implants, as the tissue is from a patient’s own body. But the procedure is more invasive and requires longer recovery time.

“Autologous reconstruction can recreate a breast that is nearly identical to the patient’s former breast,” says Dr. Devitt. “It’s a great option for many women, especially for those who have received radiation and need healthy tissue to replenish damaged tissue in the chest wall.”

Nipple and areola reconstruction

Nipple and areola reconstruction is the last step in breast reconstruction and plays a significant role in the aesthetic outcome.

You may have the option of a nipple-sparing mastectomy, which preserves your own nipple and areola. If that’s not possible, other options are available:

Tissue flap reconstruction: A surgeon shapes tissue from another part of your body, such as the thigh or abdomen, to resemble a natural nipple and areola.
3-dimensional nipple tattooing: If you prefer a non-surgical option, skilled tattoo artists use specialized techniques and customized pigments based on skin tone to create the illusion of a realistic nipple and areola.

Is breast reconstruction right for you?

Most breast cancer patients are candidates for breast reconstruction. Factors such as overall physical and mental health, the extent of the mastectomy and the presence of other medical conditions and risk factors may impact your eligibility for the procedure. Your doctor will be able to tell you which — if any — surgery is right for you.

“Breast reconstruction is a very personal decision,” says Dr. Devitt. “When considering breast reconstruction, consulting with a qualified breast reconstruction plastic surgeon is essential to guide you through the process, explain potential risks and benefits, and help you make an informed decision tailored to your goals.”

Benefits and risks of breast reconstruction

Breast reconstruction can significantly improve a woman’s body image, self-esteem and overall well-being. It also offers physical benefits, such as restoring symmetry and a more natural appearance, and makes it easier to find properly fitting clothing.

But like any surgical procedure, breast reconstruction comes with risks, including infection, bleeding, poor wound healing, changes in sensation and implant-related issues.

“Patients who are receiving radiation therapy should wait at least three to 12 months after they’re finished to begin the reconstruction process,” explains Dr. Devitt. “Radiation can be very damaging, and the tissue needs time to heal and recover. Radiation can cause problems with wound healing or infections in reconstructed breasts.”

Choosing a breast reconstruction surgeon

When it comes to breast reconstruction following a mastectomy, finding a board-certified plastic surgeon with extensive training and expertise in breast reconstruction can result in the best outcomes for patients.

Most breast surgeons will have a reconstructive surgeon they prefer, similar to the relationship between dentists and dental surgeons. Receiving a referral is often your best option.

“While breast reconstruction can never match the look and feel — and sensation — of a woman’s natural breast, this area of plastic surgery continues to advance,” Dr. Devitt continues. “Having a plastic surgeon who has a working relationship with your oncologist and breast surgeon will promise the best results and the outcome most tailored to your specific needs.”