Breast Reconstruction: Rebuilding the Breast after Mastectomy

Breast reconstruction restores the shape and appearance of the breast following mastectomy (surgical removal for breast cancer or prophylactic mastectomy). It can be performed immediately (at the time of mastectomy) or delayed (months to years later). Reconstruction is considered part of breast cancer treatment and may be covered by health insurance.

Types of Reconstruction

Implant-Based Reconstruction

The most common approach. A tissue expander is placed first to gradually stretch the skin, then replaced with a permanent implant. Alternatively, a direct-to-implant approach (with an acellular dermal matrix) may be possible in suitable patients.

Autologous Tissue Reconstruction (Flap Surgery)

Uses the patient's own tissue from another body area to rebuild the breast. More complex, longer recovery, but more natural result:

DIEP flap: uses skin and fat from the lower abdomen (without sacrificing the rectus muscle). Most common modern flap technique.
TRAM flap: similar to DIEP but includes some rectus muscle — higher abdominal weakness risk
LD flap: latissimus dorsi muscle and skin from the back — often used with a small implant

Nipple and Areola Reconstruction

A final stage, performed 3–6 months after breast mound reconstruction. Local tissue flaps for the nipple; tattooing for areola pigmentation.

Immediate vs Delayed Reconstruction

Immediate: lower total operations, better cosmetic outcomes. Delayed: allows radiation therapy to complete first (radiation significantly affects implants and healing).