Breast Reconstruction: What Is It, Types, Procedure & Recovery (2024)

What is breast reconstruction?

Breast reconstruction is surgery to recreate breasts after mastectomy or lumpectomy. Sometimes reconstruction takes several surgeries. There are many breast reconstruction techniques. Some use silicone or saline breast implants. Other techniques use a flap of tissue from your body (such as tissue from the lower belly).

Breast reconstruction can happen right after breast cancer surgery (immediate reconstruction). Or it can happen months or years later (delayed reconstruction). You may have surgery to reconstruct both breasts. Or your provider may replace one breast and reshape it to match the other. Your provider may recommend multiple surgeries over several stages.

Some people choose to have breast reconstruction after a mastectomy, but many don’t. The decision to have breast reconstruction is very personal.

What are the types of breast reconstruction surgery?

There are two main types of breast reconstruction surgery after mastectomies.

Flap reconstruction

In flap reconstruction, your surgeon takes tissue from your own body (autologous tissue) and uses it to form a breast. Usually, they take the tissue from the lower abdomen (belly). But it can also come from your thigh, back or bottom.

Your surgeon may remove fat, skin, blood vessels and muscle from these parts of your body to form a new breast. Healthcare providers call this tissue a flap. Sometimes, surgeons move a flap through your body (pedicled flap). This way the flap retains its own blood supply. Or they may detach the flap from its blood supply (free flap) and attach it to blood vessels in your chest.

The types of flap reconstruction include:

• DIEP flap: Your provider takes skin, fat and blood vessels from the lower belly. A DIEP flap does not remove the underlying abdominal (belly) muscle.
• TRAM flap: Your provider removes skin, fat, blood vessels and muscle from the lower belly.
• Latissimus dorsi (LD) flap: Providers remove tissue and muscle from the back. They transplant the LD flap (still connected to its own blood supply) through the back to the breast area.
• IGAP flap: For this procedure, tissue comes from your butt. Muscle isn’t used in this procedure.
• SGAP flap: This technique also removes tissue (not muscle) from your butt. It uses a different group of blood vessels than the IGAP flap procedure.
• PAP flap: Your surgeon removes tissue from the inner and back of your thigh and uses it to form a breast. This procedure does not transplant muscle from your thigh.
• TUG flap: Similar to a PAP flap, this technique uses tissue from your thigh. A TUG flap transplants muscle as well as tissue.
• SIEA flap (or SIEP flap): This procedure is like a DIEP flap, but it uses different blood vessels. Providers don’t use this technique as often. Few people have the blood vessels necessary for the surgery to be successful.

Implant reconstruction

In implant reconstruction, surgeons use saline or silicone implants to recreate breast tissue. Sometimes surgeons use a combination of implants and tissue from your body. Implant reconstruction can happen along with a mastectomy. Or you may choose to have this procedure after a mastectomy.

The types of implant reconstruction are:

• Under the chest muscle: Your surgeon lifts up the chest muscle and places the implant underneath it.
• Above the chest muscle: Your surgeon places the implant on top of the chest muscle. You may not need as much recovery time because your chest muscle remains in place.
• Implant with tissue expander: Your surgeon places an expander under your skin. About once per week, you or your healthcare provider fills the expander with saline. Your skin gradually expands (stretches). Your surgeon will place the implant once your skin has expanded enough to cover it.

Oncoplastic reconstruction after lumpectomy

If you are a candidate for lumpectomy, you may benefit from oncoplastic reconstruction. Your oncologic breast surgeon will help you know if you are a candidate for breast conservation. However, you’ll require radiation when a lumpectomy is performed.

In oncoplastic reconstruction, surgeons use the techniques of breast reduction or breast lift at the same time as the lumpectomy. The breast reduction or breast lift helps to fill in the defect created by the lumpectomy and improves the breast shape. You’ll need a breast reduction or lift on the other breast for symmetry.

Can a nipple be reconstructed?

Some types of mastectomy leave the nipple and areola in place (nipple-sparing mastectomy). The areola is the dark skin surrounding the nipple. If necessary, providers can create a new nipple. They do this by transferring skin from another part of your body (skin graft) or local skin on the breast to shape into a nipple.

Some people choose to get a 3D tattoo of an areola after nipple reconstruction. Specially trained tattoo artists create realistic images of an areola.

How do I know what type of breast reconstruction surgery to get?

Your provider will recommend the most appropriate technique for you based on:

• Your age, overall health and lifestyle.
• The kind of mastectomy or lumpectomy you had and how much tissue remains.
• Whether you need additional treatments for breast cancer (such as chemotherapy or radiation).
• Past surgeries you’ve had that may make it difficult or impossible to take a flap from your belly. One example is abdominal surgery.
• Your goals and desired appearance.

What does breast reconstruction treat?

Most often, breast reconstruction happens after surgery to treat or prevent breast cancer. Providers use it to reshape breasts and rebuild damaged or missing tissue. They may also perform this surgery to restore symmetry. This means they make both breasts the same size and shape. Less commonly, providers reconstruct breast tissue that results from congenital abnormalities (birth defects).

After a mastectomy, it’s normal to mourn the loss of your breast. Breast reconstruction surgery helps many people manage these strong emotions and move forward.