Breast Reconstruction

01 · Understanding reconstruction

The basics, choices & timing

Reconstruction recreates a breast mound after mastectomy, or in selected cases after lumpectomy or trauma. It does not recreate the original breast.

One or both breasts may be treated. Breast and donor-site scars are permanent. Sensation is altered: some feeling may return, but normal sensation is not guaranteed. Reconstruction does not restore breastfeeding on a mastectomy side.

Implant features are separate decisions

Filling: saline is sterile salt water inside a silicone shell; rupture usually causes deflation and the fluid is absorbed. Silicone gel rupture may be silent, without collapse. Shape: round versus anatomical is different from gel cohesiveness; cohesive does not always mean teardrop. Rotation of a shaped implant can distort contour. Surface: discuss smooth/textured trade-offs, rippling and movement; textured implants carry higher BIA-ALCL risk. Availability varies.

02 · Before surgery

Consultation & preparation

A useful consultation connects your cancer care, health, anatomy and priorities. Anxiety or uncertainty deserves support, not exclusion.

Prepare safely with your team

• Arrange a medical evaluation and indicated tests. Review aspirin, anti-inflammatory medicines and supplements that may increase bleeding.
• Do not stop prescribed anticoagulants, hormone or cancer medicines yourself. Changes require coordination with the prescriber and oncology team.
• Follow the team’s nicotine-cessation plan and instructions on fasting, washing and medicines on the day of surgery.
• Arrange transport, an adult for the first night after discharge and longer help when needed, including childcare and household tasks.

Questions to take home

Who coordinates my oncology and reconstruction plan? How could radiation change it? Which donor site is suitable, and why? Is microsurgery needed? How many stages might I need? What support and time away from work or caring duties should I arrange?

A second opinion and time to consider choices are reasonable. Emotional or reconstructive-nurse support is an option, not an eligibility test.

03 · Your individualized plan

Techniques & tissue options

Implants and living-tissue flaps are different routes. The best fit depends on your tissue, treatments, health, desired volume and specialist expertise.

Implant reconstruction

Two stages: a temporary tissue expander is gradually filled at clinic visits, then exchanged for an implant. Direct-to-implant: selected patients avoid an expander, but may still need later surgery. Placement may be above the pectoral muscle (prepectoral) or partly below it, depending on tissue coverage and circulation. An acellular dermal matrix (ADM) may provide a scaffold in selected cases; discuss product-specific risks: it does not eliminate infection or rejection-related problems.

Autologous flaps transfer your own skin, fat, blood vessels and sometimes muscle. A pedicled flap stays attached to its blood supply as it moves to the chest. A free flap is disconnected, then its vessels are rejoined to chest vessels by microsurgical anastomosis; a specialist team and flap monitoring are essential.

Flap / donor site	Tissue and connection
TRAM · abdomen	Includes part of the rectus abdominal muscle; pedicled or free.
DIEP · abdomen	Skin, fat and vessels; muscle preserved, but vessels are dissected through muscle. Free flap.
SIEA / SIEP · abdomen	Same skin/fat region, different superficial vessels; muscle-sparing free flap only if vessels are suitable.
LD · back	Latissimus dorsi muscle, with or without skin/fat; usually pedicled, rotated or tunneled to the chest; often combined with an implant.
SGAP / IGAP · buttock	Skin, fat and vessels; muscle-sparing free flaps. Not buttock fat injection.
TUG / TMG · thigh	Inner-thigh skin/fat and gracilis muscle; free flap.
PAP · thigh	Upper-thigh skin, fat and vessels; muscle-sparing free flap.

Donor scars, contour change and weakness depend on the flap. Muscle preservation does not mean zero weakness, bulge or hernia risk; LD may affect shoulder function. Tissue volume, vessel anatomy and past scars influence suitability. An abdominal flap is not a guaranteed tummy tuck.

Optional finishing stages

Fat grafting (lipofilling) uses processed fat from your own body to refine contour; some is resorbed and repeat treatment may be needed. Nipple preservation depends on cancer/anatomy and the breast team. Later nipple/areola reconstruction or 3D tattooing and opposite-breast symmetry surgery are optional; neither restores normal sensation nor guarantees appearance.

04 · After surgery and beyond

Recovery & follow-up

Recovery involves the breast and any donor site. Your written plan (not a universal calendar) guides each stage.

Cancer follow-up is not implant monitoring

Reconstruction does not eliminate cancer risk or replace oncology follow-up. After mastectomy, the reconstructed side usually does not have routine screening mammograms; clinical monitoring and assessment of symptoms continue. Any remaining native breast continues screening. After lumpectomy, breast surveillance continues. Nipple-sparing cases and local protocols may differ: follow your breast-oncology imaging plan.

Separately, silicone implants need ultrasound or MRI monitoring for silent rupture according to device guidance and the clinical team. Keep device records; ask for a written schedule. New swelling, a lump, pain or a change needs assessment now, not at the next scheduled scan. Tell the imaging team about implants, reconstruction and any fat grafting.

05 · Benefits and trade-offs

Risks & informed consent

Every reconstruction has trade-offs. Your team should explain your personal risks and alternatives before you give informed consent.

Rare implant-capsule cancers

BIA-ALCL is a rare lymphoma usually in fluid or the scar capsule around an implant; it is not ordinary breast cancer. Risk is higher with textured implants. Other rare capsule cancers, including squamous cell carcinoma (SCC) and other lymphomas, have been reported. Persistent late swelling, a lump, pain or a new change needs prompt assessment and possibly imaging, fluid or tissue tests.

Reported systemic symptoms

Some people report fatigue, joint pain, “brain fog” and other symptoms, often called breast implant illness. Causes and links to implants are not fully understood; these reports do not prove that implants cause autoimmune disease. Symptoms deserve discussion and clinical evaluation.

For chest pain, breathing difficulty or collapse, seek emergency care. For fever, worsening redness or drainage, contact your team urgently. Do not wait for routine follow-up for a suspected flap circulation problem.

06 · Planning ahead

Choosing your surgeon & cost

Choose an appropriately qualified reconstruction team and a coordinated care pathway, not simply a technique or the lowest quote.

What to look for

• Appropriate qualifications and authorization to practice; experience in breast reconstruction and the proposed approach.
• For free flaps, a microsurgeon who regularly performs these operations, a specialist team and a facility experienced in flap monitoring and urgent reoperation.
• An appropriately approved, equipped facility, qualified anesthesia care and a clear emergency pathway.
• Coordination with your breast surgeon, oncology and radiation teams, without delaying necessary cancer care.
• Time to discuss alternatives without pressure, written aftercare and accessible long-term follow-up.

A decision you can revisit

Take your written plan home. A second opinion, an external prosthesis, flat closure or no reconstruction may better suit your priorities. Delayed reconstruction remains possible for suitable patients; needing time or emotional support does not make your choice less valid.