Breast Reconstruction Frequently Asked Questions

What is the process for breast reconstruction? 

Some patients are eligible for immediate reconstruction via oncoplastic breast cancer surgery. This technique removes cancer and restores a natural-looking breast in one procedure. You may still need radiation therapy after surgery.

You can also discuss breast reconstruction after you complete treatment. This approach may be necessary if it’s a complex cancer. Regardless of when you start considering reconstruction, our team explains which option fits your needs and guides you through the entire process.

What happens at my first meeting with the surgeon?

You’ll receive personalized recommendations that reflect your:

• Cancer treatment plan, including how much breast tissue may remain after surgery
• Body type and preferences
• Health history, including prior surgeries or other medical conditions

You are welcome to bring a friend or family member to care appointments. This person can help you remember everything we discuss so it’s a little easier to make decisions.

What types of breast reconstruction are available after lumpectomy (partial mastectomy)?

You may be eligible for immediate reconstruction using oncoplastic breast cancer surgery. Surgeons remove cancer and use nearby tissue to restore breast shape and appearance in one procedure.  

The other option is delayed reconstruction. You undergo the lumpectomy procedure and then wait to have reconstruction. Whether it’s a few months or a few years between lumpectomy and reconstruction, it’s still possible to achieve the look and feel you desire.

What are my options if I need a mastectomy?

After a mastectomy (surgically removing all or part of one or both breasts), your options include: 

• Implant-based reconstruction: Surgeons insert a pouch filled with a saline or silicone solution into your chest. Your chest muscles and nearby ligaments help hold it in place.
• Flap-based reconstruction: We shape a new breast using healthy tissue from other areas of the body.

What happens during implant-based reconstruction? 

Implant-based reconstruction may be best if chest tissue healed as expected after mastectomy and you do not need radiation therapy. 

There are two approaches:

• Direct-to-implant: A small number of patients are eligible to receive implants during the same procedure as the mastectomy. 
• Skin expansion and implant: We perform a procedure to implant a balloon-like device into the breast area. During outpatient visits, we fill the balloon with a saltwater solution, which expands the skin, creating space for a permanent implant. We remove the device and replace it with a breast implant during a later procedure.

What are the different types of tissue flaps? 

If a flap-based procedure is right for you, care may include: 

• Abdominal free flap: This option is also known as DIEP (deep inferior epigastric perforator) flap reconstruction. Surgeons may take skin, fat and muscle tissue from your lower abdomen. We transfer the flap and its blood supply to your chest, then reshape and attach it to a nearby artery and vein. This technique typically provides the largest amount of tissue and is most breast-like in feeling. It is sometimes possible to connect sensory nerves to improve sensation.
• Latissimus flap reconstruction: Surgeons make an incision on your back near the bra line and isolate a section of fat, muscle and skin. They do not remove the flap from its blood supply. Instead, they slide it past nearby tissue to reach the chest. We may use this option by itself to create a small breast. For larger breasts, we may use this type of flap in conjunction with a tissue expander and implant.
• Thigh-based flaps: This technique may be an option when an abdominal flap is not possible, normally due to a previous abdominoplasty. We may use a transverse upper gracilis flap (TUG), which involves a small muscle from the upper thigh, blood vessels, fat and skin. The profunda artery perforator (PAP) flap uses tissue from the back of the thigh but leaves nearby muscles intact. In most cases these are smaller than the abdominal flap and sometimes two flaps may be used to make one breast.

How soon after mastectomy can I have reconstruction?

The timeline for breast cancer reconstruction depends on many factors. We typically wait three to four months between mastectomy and reconstruction. It may be longer, depending on whether you need chemotherapy or radiation.

What is surgery recovery like? 

You’ll feel sore and need to take some precautions to keep your recovery on track after breast reconstruction surgery. These include wearing specific types of bras and avoiding strenuous physical activity.

What else can I expect after breast reconstruction surgery?

There will be frequent follow-up visits with your surgeon and cancer care team. A few days after discharge, we see you in our clinic to remove surgical drains and ensure you are healing as expected. 

Who covers the cost of reconstructive surgery? 

Insurance typically covers reconstruction for the breast affected by cancer. It’s part of the Women’s Health and Cancer Rights Act, which mandates the availability of reconstructive surgery following mastectomy. 

Insurance also covers efforts to make sure both breasts have a consistent appearance, even if one is cancer-free. We explain how your specific coverage works and whether there will be out-of-pocket expenses.