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An Introduction to Breast Reconstruction

by Kathy Steligo

If you’re facing mastectomy, whether you’ve been diagnosed with breast cancer or you’re acting prophylactically to reduce your risk, you have a decision to make: what will you do about your missing breasts? You may choose to do nothing. Perhaps you prefer to wear prosthetics. Surgical reconstruction offers a more permanent option. Although reconstruction can’t replace lost sensation or restore the ability to breastfeed, it can restore a natural profile in and out of clothing.

Generally, reconstruction is completed in three stages over six to eight months. The initial surgery forms breast mounds, breasts without nipples. This first stage is the most complex and involves the most recovery. Depending on the procedure used, an additional shorter surgery refines the shape and size of your new breasts and creates nipples. Later tattooing simulates the areolas and completes the process.

For most women, reconstruction can be done anytime. Immediate reconstruction performed with mastectomy surgery is advantageous, however, because it produces minimal scarring and you’re never without a breast. Delayed reconstruction, performed months or years after mastectomy, produces good results, but the mastectomy scar remains on the new breast. If your insurance company covers mastectomy, federal law requires that it also pay for reconstruction.

Implants. The least invasive procedure uses implants for shape and volume. Saline implants are quite firm, like a water balloon filled to capacity. Silicone models, although more controversial, have a texture and consistency more like breast tissue. Temporary implants called expanders are first placed under the chest muscles. Over several weeks they are gradually inflated with saline to stretch the skin and muscles. During a subsequent minor surgery, the expanders are replaced with implants. Some physicians use hybrid expander-implants: when fully expanded, they are sealed and remain in place, eliminating the need for exchange surgery. A newer technique uses AlloDerm®, a processed skin product, to cover and hold the implant in place, eliminating the expansion process altogether.

Implants aren’t permanent. Sooner or later they wear out and must be removed and/or replaced. This may occur sooner if the implant leaks or is distorted by hard scar tissue that forms around it. Some implants must be replaced within a year of reconstruction; others may last for 15 years or longer.

Tissue Flaps. Breasts can also be recreated with skin and fat from your back, buttocks, or abdomen (the latter option also provides a tummy tuck). More traditional tissue flap methods utilize the underlying muscle; newer sophisticated methods do not. Breasts made with your own tissue feel and move more naturally than those reconstructed with implants. However, tissue flap procedures are more complex and recovery is more intense—this involves surgery at the chest and the donor site—but the overall reconstruction timeline is shorter. Unlike implants, flaps form full-size breasts during the initial operation. Additional surgery later refines the breast shape and creates the nipples.

Flap reconstruction may be a good choice if your chest has been irradiated or if you want to avoid the lengthy implant expansion process. Implants may be a better solution if you want to avoid a longer recovery from flap surgery or don’t want to scar another area of your body.

Four Reconstruction Planning Tips

  1. Understand all your options.
  2. Consult with several plastic surgeons.
  3. Set realistic expectations.
  4. Select a surgeon who is experienced with your preferred technique.

Editor Kathy Steligo is author of “The Breast Reconstruction Guidebook” (800-431-1579 or


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