Breast Reconstruction after Mastectomy

What is Breast Reconstruction?

Breast reconstruction is a field in plastic surgery that involves the restoration of breast size, shape and appearance following a mastectomy.

Unfortunately, with over 1 in 9 women in the United States diagnosed with breast cancer, this field of plastic surgery has become very common. But thankfully, advancements in the field have resulted in women not having to sacrifice their appearance in the face of breast cancer diagnosis and treatment.

Enhancing your appearance with Breast Reconstruction

Breast reconstruction is a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.

The creation of a new breast can dramatically improve your self-image, self-confidence and quality of life.

The role of your plastic surgeon in this process is not only to perform an excellent reconstruction, but to choose the right procedure for your particular situation.

Breast Reconstruction Techniques

Tissue Expander and Implant Technique

Reconstruction with tissue expansion involves the stretching of the the skin and soft tissue left behind on the patients chest wall following a mastectomy. This is done with a temporary implant called an expander, that is usually placed at the same time as the mastectomy.

Implant breast reconstruction
The expander and final implant are usually placed behind the pectoralis major muscle

The expander is placed with very little fluid inside of it. Once the overlying skin is healed, it is gradually filled with saline on a weekly basis. As the expander fills, it stretches the overlying skin and forms a breast mound.

The entire expansion process takes approximately 3-4 months to complete. When the size of the expander matches the desired breast size, it is removed in a second surgery and replaced with a soft, silicone gel implant. The opposite breast is usually treated with a lift or augmentation to help match the reconstructed. breast.

This type of reconstruction is the most common type used in the United States today. Benefits include safety and ease of surgery, reliability, and high patient satisfaction.

Drawbacks include the need for a 2nd surgical procedure to remove the expander, and the need to monitor the final implant for symmetry, capsular contracture, and any complications stemming from the use of an implant.

Breast Reconstruction with staged Tissue Expander/Implant technique and Nipple-Areolar reconstruction
Breast Reconstruction with staged Tissue Expander/Implant technique in patient with Nipple Sparing Mastectomy
Unilateral Breast Reconstruction with staged Tissue Expander/Implant technique and Nipple-Areolar Reconstruction with matching procedure on opposite side using an Augmentation Mammaplasty

Autologous Tissue or Flap Techniques

Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support the use of a breast implant. In these cases, tissue from other parts of the body are transferred to the chest wall to create a breast mound.

Autologous refers to your own tissue being used to reconstruct the breast. This can be combined with implants to perform a hybrid type of reconstruction.

Flap is a term used in plastic surgery that refers to a tissue or a group of tissues that with a specific blood supply is used to reconstruct a defect in the body.

DIEP and Tram Flaps

DIEP and TRAM flaps use abdominal donor muscles, fat and skin from a to reconstruct the breast. If the flap is completely detached from the abdomen and replaced on the chest wall with microsurgical techniques, it is called a DIEP flap. If it is left attached to the original blood supply and tunneled up to the chest wall, it is called a TRAM flap. Once the tissue is placed on the chest wall, it is formed into a breast mound.

In TRAM or DIEP Flap technqiues, abdominal tissue is transfered to the chest wall
TRAM or DIEP Scars
Scars associated with a TRAM or DIEP flap technique

Latissimus Dorsi Flap

A latissimus dorsi flap uses muscle, fat and skin from the back that is lifted off underlying attachments, keeping its blood supply intact, and tunneled to the mastectomy site.

Occasionally, the flap itself can reconstruct a complete breast mound. However, it is more commonly used with an implant to provide more volume.

Latissimus flap technique
Back tissue including skin and muscle is transferred to the anterior chest wall
Latissimus flap technqiue2
The skin from the back is used to create a breast mound
Latissimus flap back scar
Back scar following a Latissimus flap breast reconstruction
Breast Reconstruction with Latissimus Flap and Tissue Expander on Side affected by Radiation Therapy. Opposite side reconstructed with Tissue Expander and Wise pattern mastectomy.

Other Flap Techniques

Alternatively, one may choose to use the SGAP flap techniques which uses tissue from the Buttock Region.

Nipple and Areola Reconstruction

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola. These procedures are minor and can be done in the office. The areaola is usually reconstructed with a tattoo.

Nipple-areolar tattoo after reconstruction with implants

Recovering from a Breast Reconstruction Procedure

Following the surgery, bandages and/or gauze is applied to the incisions. Patients also receive a support bra or elastic bandage to reduce swelling and support their reconstructed breasts. Dr. Thomassen may place a small tube just beneath the skin to drain extra fluid and blood.

All patients receive specific instructions that relate to their particular surgery. These instructions include information about medications, follow-up appointments and symptoms that indicate the patient needs to seek medical attention.


It takes several weeks for inflammation to decrease and the breasts’ shape and position to improve. As time passes, many women will experience the return of some breast sensation, scar lines will become less visible.

If you have had a mastectomy and are interested in learning more about the breast reconstruction procedures that are available in Fort Lauderdale, contact Thomassen Plastic Surgery today.

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