Breast Reconstruction

There are two main types of breast reconstruction: implant-based reconstruction, and reconstruction using a patient’s own tissue (“autologous tissue,” where auto means self). Both types of breast reconstruction can give you a natural shape and appearance. Both types of breast reconstruction are safe and effective. You and your surgeon will have an in-depth discussion to determine which type of reconstruction is best for your particular case.

In general reconstructive terms, the breast is made of the skin envelope (the outer covering of the breast), the breast mound (the tissue that gives the breast more volume, or cup size), and the nipple-areolar complex. Breast reconstruction is often performed in a series of surgical and non-surgical procedures to reconstruct each component of the breast. From start to finish, the entire process takes about 8-12 months. However, every patient is different, and your particular process may be shorter or longer.

First stage: The skin envelope

Months 0 -2

After mastectomy, normally the chest skin heals flat against the chest wall. To recreate the extra skin that previously covered the breast, a tissue expander is inserted underneath your skin and the pectoralis muscle. A tissue expander works like a balloon under your skin. It is filled with saline solution in order to amplify your skin envelope to accommodate the future breast mound. The filling process occurs in the clinic over 6-8 weeks until the skin envelope has achieved the desired size.

The Skin Evenvelope - Step 1:

After mastectomy

The Skin Evenvelope - Step 2: Insert Tissue Expander

Tissue Expander Inserted

The Skin Evenvelope - Step 3: Larger Skin Envelope

Larger Skin Envelope
(6 – 8 weeks)

Second stage: The breast mound

Months 2 – 3

Next, the breast mound is reconstructed using either a breast implant or autologous tissue.

Breast Implants

Implant-based reconstruction

Once the tissue expander has reached the desired size, you will have another surgical procedure to exchange the tissue expander for a permanent implant. Breast implants come in many different shapes, sizes, and materials (silicone vs saline). You and your surgeon will have an in-depth discussion about which implant is right for you.

My Own Tissue

Autologous tissue reconstruction

Using microvascular tissue transfer techniques, extra tissue from the abdomen, inner thighs, back, or buttocks can be used to reconstruct the breast mound. The size of the reconstruction depends on the size of your own tissue. You and your surgeon will have a detailed discussion about which donor site is right for you.

Extra tissue from the belly can be used to reconstruct the breast mound. One procedure that I offer is called DIEP breast reconstruction, which stands for deep inferior epigastric artery perforator breast reconstruction. The skin and fat of the lower abdomen are nourished by two small arteries that run upward, from each groin to either side of the belly button. This artery is the deep inferior epigastric artery (DIEA).

  • image: diagram of DIEP procedure

As the artery moves up toward the belly button, it gives off small branches. Those branches are called perforators because the branches penetrate through the muscle and fat to reach the overlying skin. When the belly tissue is removed from the abdomen, the accompanying DIEA and its perforators are removed with tissue. The DIEA is then connected to an artery in the chest wall called the internal mammary artery, allowing blood to flow to the breast mound. This connection between the arteries is what allows the belly tissue to survive in its new home on the chest wall, and what allows the belly to become a breast mound.

Third stage: Establishing symmetry

Months 3 – 6

Every woman has some degree of breast asymmetry, even before mastectomy. The goal of breast reconstruction is to restore as much symmetry as possible. The reconstructed breast may require additional procedures to better match the native breast, or vice-versa. These procedures may include mastopexy (breast lift), breast reduction, breast augmentation, or fat grafting. The third stage of breast reconstruction is highly individualized and tailored to each patient’s personal preference.

Fourth stage: Nipple reconstruction

Months 6 – 9

Once the reconstructed breast has the desired symmetry with the native breast, nipple reconstruction can take place. This is a short procedure performed in the clinic that uses the skin overlying the breast mound to create a new nipple.

Final stage: Nipple-areolar tattoo

Months 9 – 12

Once the reconstructed nipple has healed, tattoos will restore the natural pigment of the nipple-areolar complex.