If you’ve been diagnosed with breast cancer or are planning to have a preventive mastectomy, you’ll want to know about breast reconstructive surgery to decide if it’s right for you. Breast reconstruction can be done in a variety of ways to rebuild your breast or breasts.
Discuss your options with your breast surgeon and plastic surgeon as soon as possible if you’re considering breast reconstruction. It’s important to understand how the type of surgery you have can influence your reconstructive options.
It’s common — and normal — to feel anxious, stressed, frightened, or even mournful about losing a breast. You may wonder how it will affect your body image, sex life, and self-confidence, and how you will look in clothes. As you weigh your options, use this guide to learn about the latest ways to reconstruct the breast and what’s involved in each procedure.Back to top
It’s possible to have breast reconstructive surgery any time after a mastectomy — even years later. Many women, however, choose to start reconstruction at the same time as their breast cancer surgery. This is known as immediate reconstruction. Your doctor will help you make this decision. The benefits include avoiding a second hospital stay, not having to undergo anesthesia twice to start the reconstruction process, and smaller breast scars. Some women say that having immediate reconstruction made losing a breast feel less traumatic. But either option may be right for you.Back to top
The first step is deciding what type of breast reconstruction is right for you. Broadly speaking, there are two ways to rebuild the breast: using a synthetic implant or using tissue from another part of your body (often called flap surgery). If only one breast is affected, your doctors may recommend having some kind of surgery on the other breast — such as a breast lift, breast reduction, or breast augmentation — to help match both breasts as closely as possible.
Discuss the pros and cons of each reconstruction option with your doctors. The right choice for you can depend on your age, health, body type, breast size, the location of your cancer, the stage of your cancer, your lifestyle, and your personal preferences.Back to top
Tissue-transfer breast reconstruction, flap breast reconstruction, and autologous reconstruction are surgeries in which tissue from another part of a woman’s body is used to reconstruct her breast after a mastectomy. “Autologous” is the medical term for someone’s own tissues.Back to top
There are two ways to do tissue flap surgery. In one, a flap of tissue is moved to the chest along with its original blood supply; this is a pedicle flap. For free flap, which is the second option, the tissue is disconnected from its original blood supply and reconnected to blood vessels in the chest. The vast majority of tissue flap breast reconstructions performed at MSK are free flaps.
There are several types of tissue flap surgery. They are named for the part of the body where the tissue comes from:
- DIEP (deep inferior epigastric perforator) flap refers to the use of excess lower abdominal skin and fat to reconstruct the breast. The incision for this procedure is similar to an abdominoplasty (a “tummy tuck”). Your plastic surgeon sculpts the excess skin and fat that is removed to recreate the breast. The name for this procedure is derived from the blood vessels that provide nutrients to the tissue. These blood vessels are disconnected from the abdomen and reconnected to blood vessels in the breast by your plastic surgeon using a microscope.
- Muscle-sparing TRAM (transverse abdominus myocutaneous) flap is similar to a DIEP flap. In this procedure, however, a small segment of the abdominal muscle is kept connected to the blood vessels that are moved. This procedure is occasionally used in patients who have very small blood vessels or who have had previous abdominal scars.
- SIEA (superficial inferior epigastric artery) flap is also similar to a DIEP flap, but in this case, a different set of blood vessels is used to resupply the abdominal tissues. This blood supply is present in some patients but not others.
- TUG (transverse upper gracilis) flap uses tissue and muscle from the inner upper thigh. The scar is hidden in the natural groin crease.
- DUG (diagonal upper gracilis) flap is very similar to a TUG flap except that in DUG, the scar is angled diagonally.
- Gluteal free flap uses tissue from the upper or lower buttocks for breast reconstruction.
- PAP (profunda artery perforator) flap uses tissue from the back of the thigh, just below the buttocks.
Breast implants come in a range of sizes and shapes. They are made of a flexible silicone outer shell that is filled with saline (sterile salt water) or with silicone gel (a semisolid or solid gelatinous material). Anatomical form-stable implants, also called “gummy bear implants,” contain very thick silicone gel that holds its shape even if the outer shell breaks. Most women choose silicone gel implants because they’re softer and feel more like the breast’s natural fatty tissue than saline implants.
Breast implant surgery is usually a two-step process. First, a tissue expander (an empty balloonlike plastic sac) is inserted under the chest (pectoral) muscles. Over several weeks, using a syringe, the bag is gradually inflated with saline to stretch the muscles and breast skin to the desired size. During a second, shorter surgery, the expander is removed and replaced with the saline or silicone gel breast implant. In some cases, the final implant can be placed immediately after a mastectomy, skipping the expander step.Back to top
Yes, breast implants are safe. Both silicone gel and saline implants are FDA approved. Despite concerns raised many years ago that silicone gel implants might raise the risk for autoimmune diseases, such as lupus or arthritis, the FDA reports that studies of more than 80,000 women have not found any higher rates of these diseases in women with silicone gel implants. There is no evidence linking breast implants to an increased risk for breast cancer either.
However, recent studies suggest some people are at a low risk of developing a rare form of lymphoma, called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This is not a breast cancer but a type of non-Hodgkin lymphoma—a disease of the immune system.Back to top
Breast implants don’t last forever. An implant’s life span varies according to its type, design, and manufacturer. It may need to be removed or replaced due to leaking, an infection, or other complications. Your doctor may advise having periodic breast MRI imaging to check for implant failure.Back to top
Women who are having immediate reconstruction usually opt for a skin-sparing mastectomy. This means that most of the skin over the breast is left intact to create a shell that will cover the reconstructed breast. In some cases, surgeons can also save the nipple and areola (the dark skin around the nipple). This is called a nipple-sparing mastectomy. If cancer has affected the nipple area or is located very close to the nipple, doctors will not be able to save it. The size and shape of a woman’s breasts may also affect whether or not surgeons can spare the nipple for reconstructive surgery. Saving the nipple does mean leaving a small amount of breast tissue underneath the nipple to provide it with a blood supply.Back to top
If it’s not possible to save the nipple during a mastectomy, your plastic surgeon can create a new one after breast reconstruction by using the skin from the breasts. The areola can also be reconstructed using skin from another part of the body, such as the upper thigh or lower abdomen. Sometimes nipple reconstruction is performed simply with a 3-D tattoo, using shading and artistic techniques to recreate a natural-looking nipple.Back to top
In many cases, a lumpectomy (breast-conserving surgery) causes very little scarring or changes to the breast and reconstruction is not necessary. If the surgery is more involved, there are several ways to enhance the appearance of the breast. Options include a breast lift, breast reduction surgery, tissue rearrangement, and, in some cases, cosmetic plastic surgery on the other breast to make them look the same.Back to top
Fat injection, also known as fat grafting, is another way to improve the appearance of the breast after cancer surgery. Using liposuction, fat is collected from another area of your body, then injected into any dimpled areas where the breast tissue has been removed to plump up the breast.Back to top
Microsurgery and supermicrosurgery are types of surgery performed under a microscope. Tiny sutures (stitches) are used to reconnect the small blood vessels of a flap tissue to those in the breast so that the transferred tissue thrives and heals properly.Back to top
Recovery time depends on which surgery you have:
- After breast reconstruction using a tissue expander or an implant as the first step, you will need to take three to four weeks off from work to recover.
- With natural-tissue flap reconstruction, recovery can take four to eight weeks, at which time most patients can resume their work and usual lifestyle.
However, complete healing from these procedures usually takes a few months.Back to top
Your new breast will not function like a normal breast. It will no longer be able to produce milk, and it won’t be sensitive to touch. But depending on the method of reconstruction, it can look similar to your other breast, especially in clothing.Back to top
Some women choose not to have breast reconstruction after a mastectomy. Another option is wearing a breast prosthesis, an insert that tucks into a special pocket in a bra or swimsuit so that breasts look symmetrical. Breast prostheses are available in a wide range of sizes, shapes, and skin tones and in a variety of materials, including silicone gel, foam, and fiberfill.Back to top
Our highly trained plastic and reconstructive surgeons are internationally recognized experts in all types of breast reconstructive surgery. We perform more hundreds of breast reconstructions each year that include immediate reconstructions, complex reconstructions done years after breast cancer treatment, and revision surgeries on women who are unhappy with their original reconstruction surgery.
At MSK, our surgeons collaborate with medical oncologists, dermatologists, radiation oncologists, and more on each patient so we can evaluate and meet your goals and minimize recovery time. Ultimately, we want to help you get back to being you.
Choose the MSK Center for Advanced Reconstruction because we offer:
- The latest breast reconstruction techniques. These include surgeries using new types of implants or tissue from other areas of your body, such as DIEP and SIEA flaps (tummy tuck); SGAP flap (buttock tissue); and PAP, TUG, and DUG flap (thigh tissue). Our surgeons are highly skilled at new microsurgery techniques that lead to better outcomes and fewer complications.
Our doctors led the largest study to date of new sizes and shapes of implants specifically designed for reconstruction, leading to FDA approval of teardrop-shaped implants (also known as “gummy bear” implants) that better match the breast’s natural anatomy and hold their shape over time.
- Compassionate care from a team of experts before, during, and after your surgery. This includes skilled care from nurses who specialize in working with patients who are recovering from breast cancer surgery and breast reconstruction. They’ll care for you both at your bedside while you are in the hospital and in our surgeons’ offices as you recover to help deliver the best follow-up care during postsurgical checkups. Learn more about what to expect after reconstructive surgery.
- A commitment to patient satisfaction. We track satisfaction and use those results to continuously improve outcomes and quality of life for our patients. The Breast-Q satisfaction questionnaire, which was developed at MSK and is now used around the world, helps us evaluate your unique needs.
- Rehabilitation and therapeutic exercise programs. Our team also includes physical therapists specialized in helping patients who have undergone surgery. They will help you heal and return to a full, active life after breast reconstruction.
- A dedicated site at Evelyn H. Lauder Breast Center. You can receive a surgical consultation at the center as well as a wide variety of other services, including access to integrative medicine doctors, nutritionists, and emotional support. The boutique at the center offers choices of breast prostheses and postmastectomy bras.
- Centralized care. We understand that surgery can often mean numerous appointments with several doctors in several locations. We strive to simplify scheduling and centralize care to accommodate you and your schedule.