Breast reconstruction surgery can either be done at the same time as the mastectomy or it can be done some time later. The former is called immediate reconstruction; the latter, delayed reconstruction. Delayed reconstruction used to be the most common type of breast reconstruction surgery because it allowed women some time to heal from the cancer treatment, but immediate reconstruction is becoming more common because it requires one less surgery, which is quite traumatic for the body – especially one coping with cancer treatment.

There are three types of breast reconstruction surgery: tissue flap, implant, and a combination of the two. Which type of reconstructive surgery is appropriate depends on many factors personal to each patient including overall health, nature of the breast cancer, size of the natural breast, amount of tissue available for reconstruction, and desire to match the appearance of the other breast.

Implant breast reconstruction usually uses saline implants. Silicone implants generally are not used because of concerns about autoimmune problems resulting from silicone implant rupture. However, some women may receive “double lumen” breast implants which contain a silicone implant inside of a saline implant.

If the breast reconstruction surgery is to be done at the same time as the mastectomy or lumpectomy, the surgeon will remove the cancerous breast tissue then place the implant either on or under the chest muscle. If the surgeon is unable to remove all the cancer or is uncertain, he will delay the reconstruction procedure until after testing shows that the cancer is completely removed.

Breast reconstruction surgery can either be a one-stage procedure or a two-stage procedure. If it is a one stage procedure, the surgeon will simply place an implant where the breast tissue used to be. If the skin and chest muscles are too tight, the surgeon may implant a tissue expander beneath the skin into which he injects saline solution to expand the area. Some expanders are left in place as the implant, some are later replaced with an actual implant at a later time. A procedure in which an expander is later replaced with an implant is known as a two-stage procedure.

Breast reconstruction surgery may be performed using a woman’s own body tissue. There are three types of tissue flap procedures, one called TRAM flap which uses abdominal tissue, one called the DIEP flap, which also uses abdominal tissue, and another called latissimus dorsi flap which uses tissue from the upper back. The difference between TRAM flap and DIEP flap is that TRAM flap uses abdominal muscle as well as skin and fat, whereas DIEP flap only uses abdominal skin and fat. The DIEP flap procedure is ideal for women who have had a lumpectomy or have only had a small amount of breast tissue removed. The tissue flap can be a free flap, which is a flap of skin that has been completely removed from one area and moved to the other, or it can be a pedicle flap. A pedicle flap is a flap of tissue that is left connected to the body, but is tunneled to the breast area under the skin. This is usually done with the latissimus dorsi flap.

Tissue flap breast reconstruction leaves visible scars both at the location of the breast reconstruction and the location of the tissue flap. Also, since blood vessels will be cut during the surgery, it usually cannot be offered to smokers or women with diabetes or vascular diseases. Many women prefer to use their own body tissue to reconstruct the breast because it looks and feels more like a natural breast. As well, with the TRAM flap procedure, women end up with smaller, flatter bellies because so much tissue has been removed.

Recovery from breast reconstruction surgery is similar to recovery from breast augmentation surgery. A woman will be sore for a few weeks, but will be mobile after a few days even though her physical activity may be restricted. Sometimes, however, it can take longer to heal from breast reconstruction surgery because the body’s ability to heal may be slowed or compromised due to cancer treatment.

After breast reconstruction surgery, the new breast may feel firmer and look rounder or flatter than the natural breast. Fortunately, these discrepancies will usually only be visible if the woman is nude. Even so, most women who have undergone breast reconstruction surgery find that it dramatically improves the quality of their lives and appearance.

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