Breast Reconstruction Surgery After Mastectomy

Breast reconstruction surgery may be right for you. But you need information before you can make a choice. Perhaps you need breast reconstruction after a mastectomy, or breast reconstruction after a double mastectomy. We explain all options to help you make that choice.

MSK surgeons do nearly 3,000 breast reconstruction procedures each year, among the highest number in the country.
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Overview of breast reconstruction surgery

You may be stressed by many hard choices about breast reconstruction after a mastectomy.

Learning you have breast cancer can be overwhelming. You may have already had a mastectomy, a surgery to remove 1 or both breasts.

Some people feel the loss of their breasts is almost as challenging as coping with cancer. Breast reconstruction rebuilds your breast or breasts.

Breast reconstruction can be done in a few ways. This page offers information about those options.

The MSK Difference

Experts at MSK’s Center for Advanced Reconstruction help you look your best. We have breast surgeons who do mastectomies, plastic surgeons who reconstruct breasts, and experts in nipple tattoos. They work with your cancer doctor on a surgery treatment and breast reconstruction that’s best for you.

What is breast reconstruction?

The goal of breast reconstruction after a mastectomy or a double mastectomy is to restore a breast mound, or mounds. If only one breast is affected, surgery also can be done on your other breast. This helps the reconstructed breast look more like your natural breast.  

There are 2 ways to rebuild the breast:

  • Use an implant
  • Use tissue from another part of your body. This is called flap surgery, or autologous (aw-TAH-luh-gus) reconstruction.

You do not have to have breast reconstruction after a mastectomy or double mastectomy.

Some people choose to have a breast reconstruction months or even years later. It’s often possible to delay reconstruction.

Talk with your doctor about your options for breast reconstruction in the future. You also may just choose to go flat after a mastectomy or double mastectomy. 

Plastic and reconstructive surgeon Dr. Colleen McCarthy during surgery.
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Breast implant reconstruction surgery

Breast implants after a mastectomy are the most common choice for breast reconstruction. They’re made of a silicone shell filled with either saline (sterile saltwater) or silicone (gel). They come in many sizes and shapes.

Some people get implants in both breasts, even if they’re having a single mastectomy (1 breast). This helps both breasts look the same. It’s not always easy to match an implant with your own real breast. 

Here are some reasons you may want breast implants:
  • You can return to normal activities faster than flap reconstruction
  • You want to return to normal activities as soon as possible
  • You do not have enough body tissue for flap surgery
  • You do not want scars on other parts of your body 
Dr. Michelle Coriddi is a plastic and reconstructive surgeon
There are many options for reconstruction. Deciding on the best one is personal.
At MSK, plastic surgeons such as Michelle Coriddi help you choose the best reconstruction options. They will talk with you to understand what option you think is best.
Read more

What is the breast implant reconstruction process?

Breast implant reconstruction starts with a temporary implant, called a tissue expander. The tissue expander is filled with a small amount of saline or air. Your surgeon will place it under or over the chest muscle during your mastectomy.    

Tissue expanders have a built-in valve that lets them slowly fill with saline. You’ll start about 2 weeks after surgery. It takes around 2 to 6 outpatient visits to fill the expander. 

The next step is to have outpatient surgery to replace the tissue expander with a permanent implant. But first, your skin must be healed. You also must be done with breast cancer treatments, such as chemotherapy, radiation, or both.

The MSK Difference

Our surgeons are highly trained in all types of breast reconstruction. They do nearly 3,000 breast reconstruction procedures each year, among the highest number in the country. They do complex reconstructions, and surgeries on people who are unhappy with their original reconstruction.

What are the types of breast implant reconstruction?

Reconstruction with breast implants is an option that can get you back to normal, daily life faster.

There are 2 general approaches to this surgery. 

The most common method is with a tissue expander. Less often, we offer a permanent implant during mastectomy surgery. 

Here’s more information about these 2 options:

With tissue expanders, the process for breast implants will take months to finish. During this time, you can do many of your regular activities.

In general, you only need to stay 1 night at the hospital. Recovery can take anywhere from 4 to 6 weeks.

Direct-to-implant surgery is done at the same time as a mastectomy. Sometimes we can place a permanent implant during the mastectomy. There is no need for a tissue expander or a second surgery. 

This method is best for people who do not smoke, have small breasts, and want small implants.

In general, you only need to stay 1 night at the hospital. Recovery can take anywhere from 2 to 4 weeks.

An MSK physician assistant does a nipple tattoo procedure.

MSK experts have special training in adding tattoos of nipples and areolas after breast cancer surgery.

Autologous tissue reconstruction

Reconstruction using your own tissue is called autologous (aw-TAH-luh-gus) surgery or flap surgery.

Most often, the tissue is skin, fat, and sometimes muscle. It’s your own tissue, so you get a breast that looks and feels more natural than implants.

The timeline for surgery and recovery is similar for all types of autologous breast reconstruction. 

Types of autologous tissue reconstruction:
DIEP flap (belly) surgery
We make a new breast by sculpting tissue from your lower abdomen (belly).
DIEP flap (belly) surgery

Your plastic surgeon will make an incision (cut) across your lower abdomen. They will move a flap of tissue with its blood vessels up to your chest. 

They make a new breast. They sculpt this tissue and connect the flap’s blood vessels to blood vessels in the chest.

Who it’s for 

DIEP flap is best for people who: 

  • Have extra belly tissue that can be used to make a breast
  • Do not want an implant
  • Want to avoid lifelong imaging to monitor the implant 
  • Are OK with taking longer to recover

Why it’s good

DIEP flap surgery is good for a few reasons. You get a flatter, tighter belly. It’s easy to hide the scar near the bikini line. It also ages in a more natural way, as you gain or lose weight.

What to think about

Here are some things that can keep you from getting DIEP flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • You have had blood clotting conditions
  • You smoke
  • You already had certain types of abdominal surgery 
Up Next
DUG, PAP, LTP (thigh), and GAP (butt) free-flap surgery
DIEP flap (belly) surgery

Your plastic surgeon will make an incision (cut) across your lower abdomen. They will move a flap of tissue with its blood vessels up to your chest. 

They make a new breast. They sculpt this tissue and connect the flap’s blood vessels to blood vessels in the chest.

Who it’s for 

DIEP flap is best for people who: 

  • Have extra belly tissue that can be used to make a breast
  • Do not want an implant
  • Want to avoid lifelong imaging to monitor the implant 
  • Are OK with taking longer to recover

Why it’s good

DIEP flap surgery is good for a few reasons. You get a flatter, tighter belly. It’s easy to hide the scar near the bikini line. It also ages in a more natural way, as you gain or lose weight.

What to think about

Here are some things that can keep you from getting DIEP flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • You have had blood clotting conditions
  • You smoke
  • You already had certain types of abdominal surgery 
Up Next
DUG, PAP, LTP (thigh), and GAP (butt) free-flap surgery
DUG, PAP, LTP (thigh), and GAP (butt) free-flap surgery
We make a new breast using tissue from your upper inner or outer thigh. The tissue is transplanted to your chest to sculpt a new breast.
DUG, PAP, LTP (thigh), and GAP (butt) free-flap surgery

To make a new breast, your plastic surgeon takes tissue and its blood supply and transplants it to your chest. This leaves a scar on either the:

  • Inner or outer thigh area
  • Upper thigh just below the crease in your buttocks (butt).

Most often, we do a thigh flap reconstruction because we can’t take tissue from the abdomen. 

More about DUG, PAP, LTP and GAP free-flap surgery:

Who it’s for

Thigh or buttocks free-flap procedures are best for people who:

  • Cannot have tissue taken from their abdomen
  • Do not want an implant in their body
  • Want to avoid lifelong imaging to monitor the implant 
  • Are OK with taking longer to recover

Why it’s good

The reconstructed breast:

  • Looks natural
  • Ages in a natural way
  • Adjusts to you losing or gaining weight

What to think about

This type of surgery is not right for everyone. Here are some of the things that can keep you from getting thigh or buttocks flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • You have had blood clotting conditions
  • You smoke
  • You already had certain types of abdominal surgery 

 

Up Next
Latissimus dorsi flap (back) surgery
DUG, PAP, LTP (thigh), and GAP (butt) free-flap surgery

To make a new breast, your plastic surgeon takes tissue and its blood supply and transplants it to your chest. This leaves a scar on either the:

  • Inner or outer thigh area
  • Upper thigh just below the crease in your buttocks (butt).

Most often, we do a thigh flap reconstruction because we can’t take tissue from the abdomen. 

More about DUG, PAP, LTP and GAP free-flap surgery:

Who it’s for

Thigh or buttocks free-flap procedures are best for people who:

  • Cannot have tissue taken from their abdomen
  • Do not want an implant in their body
  • Want to avoid lifelong imaging to monitor the implant 
  • Are OK with taking longer to recover

Why it’s good

The reconstructed breast:

  • Looks natural
  • Ages in a natural way
  • Adjusts to you losing or gaining weight

What to think about

This type of surgery is not right for everyone. Here are some of the things that can keep you from getting thigh or buttocks flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • You have had blood clotting conditions
  • You smoke
  • You already had certain types of abdominal surgery 

 

Up Next
Latissimus dorsi flap (back) surgery
Latissimus dorsi flap (back) surgery
We make a new breast using skin, fat, and muscle from your upper back.
Latissimus dorsi flap (back) surgery

Your plastic surgeon uses skin, fat, and muscle from your upper back. Keeping its blood supply attached, they pass the flap through a tunnel under your skin to your chest. They use it to sculpt a new breast. 

LD back flap reconstruction is most often done along with a small breast implant or tissue expander. That’s because the back skin and muscle may not be big enough for a full breast.

More about LD back flap surgery: 

Who it’s for

LD flap is best for people who:

  • Cannot have tissue taken from their abdomen
  • Are OK with taking longer to recover, compared to an implant
  • Have had radiation to their chest or breast
  • Had an implant breast reconstruction that did not work

Why it’s good

The reconstructed breast

  • Looks natural
  • Ages in a natural way
  • Adjusts to you losing or gaining weight

What to think about

This type of surgery is not right for everyone. Here are some of the things that can keep you from getting back flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • It’s a longer surgery
  • It takes longer to recover
  • You smoke
  • You have other scars on your body 
Latissimus dorsi flap (back) surgery

Your plastic surgeon uses skin, fat, and muscle from your upper back. Keeping its blood supply attached, they pass the flap through a tunnel under your skin to your chest. They use it to sculpt a new breast. 

LD back flap reconstruction is most often done along with a small breast implant or tissue expander. That’s because the back skin and muscle may not be big enough for a full breast.

More about LD back flap surgery: 

Who it’s for

LD flap is best for people who:

  • Cannot have tissue taken from their abdomen
  • Are OK with taking longer to recover, compared to an implant
  • Have had radiation to their chest or breast
  • Had an implant breast reconstruction that did not work

Why it’s good

The reconstructed breast

  • Looks natural
  • Ages in a natural way
  • Adjusts to you losing or gaining weight

What to think about

This type of surgery is not right for everyone. Here are some of the things that can keep you from getting back flap reconstruction:

  • You have health conditions that do not make it safe to have a longer surgery
  • It’s a longer surgery
  • It takes longer to recover
  • You smoke
  • You have other scars on your body 

Breast neurotization

Breast neurotization (noor-oh-ty-ZAY-shuhn) is a special microsurgery method that can bring back feeling to a reconstructed (rebuilt) breast. Microsurgery with a microscope and special tools let MSK experts reconnect sensory nerves to a reconstructed breast.

Based on your body and the type of reconstruction you’re having, neurotization can restore feeling to your:

  • Reconstructed breast
  • Nipple and areola (the circle around the nipple)
  • Breast, nipple, and areola 
Restoring nipple sensation

Sensory nerves let your body feel and respond to things like pressure or touch. Surgery can harm these nerves. Sensory nerves may be affected when your nipple and areola are preserved during a nipple-sparing mastectomy.

Nipple sensitization (SEN-suh-ty-ZAY-shuhn) is microsurgery to repair the nerves that go to your nipple. We connect a sensory nerve from your chest wall to your preserved nipple and areola.

Research studies show that nipples can feel more after neurotization. Over time, the nerves will grow toward the nipple and give you back feeling in the area. Sensation slowly gets better during   the first few years after the surgery. 

Flap neurotization

You may be having an autologous (aw-TAH-luh-gus) breast reconstruction. This surgery also is called a flap surgery, such as a DIEP flap reconstruction. It uses tissue transferred (moved) from another part of your body. Flap neurotization can restore feeling to this transferred tissue.

During your neurotization microsurgery, we take a sensory nerve from your chest. We connect it to a sensory nerve within the reconstructed flap. The nerves grow back into your rebuilt breast.

We can do flap neurotization after a nipple-sparing mastectomy or a skin-sparing mastectomy. Research studies show sensation improves in DIEP flaps after a flap neurotization. Over time, you’ll keep feeling more sensations.

Restoring more than how you look and feel

When you lose sensation, you’re less able to feel something touching you. But loss of sensation also causes other things, such as:

  • Numbness
  • Discomfort
  • Changes in sensation
  • A higher chance you cannot feel heat, cold, or an injury

When surgery restores your breast sensation, you can feel touch again. But this surgery can help in other ways, too. Research studies show people who had breast neurotization report they have better breast sensation, psychosocial well-being, and sexual well-being.

MSK Recommends

If breast reconstruction is not right for you, MSK can recommend a breast prosthesis (pros-THEE-sis). This is something you tuck into a bra that makes your breasts look more even. Breast prostheses come in many sizes, shapes, skin tones, and materials.

Common questions

Common questions about breast reconstruction after mastectomy

No. Research shows breast reconstruction does not:

  • Affect the chances breast cancer will come back in the breast or another location.
  • Cause a delay in diagnosing whether breast cancer came back.
  • Change treatment for breast cancer that comes back.

There’s always some risk the cancer could return, though.

  • Local recurrence is when it comes back in the same place as where you first had cancer.
  • Regional recurrence is when it comes back in nearby lymph nodes.
  • Distant recurrence is when it comes back in places farther away.

Your care team will talk with you about ways you can lower your risk for a breast cancer recurrence.

You must avoid strenuous activities, such as jogging and tennis, until your doctor tells you it’s safe.

Your physical therapist will give you written instructions on what exercises and movements you can do while you’re healing. Talk with your doctor or nurse before your start any other exercise. 

If you’re having discomfort, it can help to take some pain medicine 30 minutes before starting exercise.

Do not have sex for at least 1 or 2 weeks after surgery. You should give your body some time to recover. After that, you can have sex whenever you feel ready physically and emotionally. 
 
It’s normal to feel nervous or to think about your body so soon after surgery. Our Female Sexual Medicine and Women’s Health Program can help. For more information or to make an appointment, call 646-888-5076.

The Jackson-Pratt® (JP) drain helps drain fluid after the surgery and prevents swelling.  

How long you will have a JP drain can vary. It depends on the surgery you had, and the amount of drainage you have. Some people drain a lot, some only a little.

My MSK team really took the time to explain things to me and show me pictures. I can’t say enough good things about the care I got. All of this felt right for me.
Monica Haba, age 38, who had a mastectomy and flap reconstruction
Last updated October 1, 2024
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