Breast Reconstruction

What is Breast Reconstruction?

Breast cancer is the most common cancer diagnosed in women, and approximately 1 in 8 women will be diagnosed with breast cancer in their lifetime. Our understanding of breast cancer has markedly improved over the past 30 years and has led to better screening and treatment options. Many women still require or choose to get mastectomies, and when learning about treatment options for your cancer, it is important to understand options for reconstruction. Breast reconstruction is a process that begins after your mastectomy and may take one or multiple operations to achieve. Breast reconstruction is a different process for every woman and may take a different amount of time for each woman. The goal of breast reconstruction is to safely restore your body to a standard you are proud of. When choosing your breast reconstruction, it is important to understand your treatment options so you can make an informed decision.

Types of Breast Reconstruction

Breast Reconstruction is not a one size fits all approach. Every woman's reconstruction should be personalized to best fit their body and their personal goals. Women have options when it comes to breast reconstruction, and it is important to understand those options.

  • Implant-Based Reconstruction

  • Autologous Reconstruction (Your own tissue)

Implant-Based Reconstruction

Breast implants are a common form of breast reconstruction. Breast implants are made by three major companies (Allergan, Mentor, and Sientra) and come in different sizes and profiles. If you elect to have implant-based breast reconstruction, it is performed in either one stage or two stages.


Most commonly, women have a two-stage reconstruction, which involves a tissue expander inserted on the same day as your mastectomy. Tissue expanders are devices that can be expanded to different sizes, depending upon the size of your native breasts and the tissue expanders. On the day of your mastectomy, tissue expanders are inserted and partially filled with saline. They are partially filled to avoid pressure on your surgical site and to facilitate healing. You will then have your tissue expanders filled further in clinic in the following weeks after surgery. The time during tissue expansion gives you time to heal from your mastectomy as well as expand your skin to your desired breast size.


One-stage reconstruction, also known as Direct-to-Implant (DTI), is an approach where a breast implant is inserted on the same day as your mastectomy. This approach is best for women who want to stay the same breast size. DTI is a lesson common approach because not every women is a candidate for a one stage approach. The factors that determine whether you are a candidate include your current and desired breast size as well as the intra-operative assessment of your mastectomy skin flaps.

Read more about the safety of breast implants here.

Autologous Reconstruction (Natural Tissue)

Breast Reconstruction can be performed using your own tissue. This is known as Autologous Reconstruction, which is an operation during which tissue from one area of the body is transferred to the chest. We connect the small blood vessels (2-3mm) from the flap to vessels in the chest. The most common donor site is the abdomen, which is known as a Deep Inferior Epigastric Perforator Flap (DIEP Flap) or a Muscle-Sparing Transverse Rectus Abdominis Muscle Flap (MS-TRAM Flap). Other donor sites include the buttocks (Superior Gluteal Artery Perforator Flap, SGAP Flap) and thigh (Profundus Artery Perforator Flap, PAP Flap).


Autologous Reconstruction uses only your own tissue for breast reconstruction. There are multiple reasons you may choose autologous reconstruction over implant-based reconstruction. The most common reason is the need for radiation for breast cancer treatment. While it is possible to have implant-based reconstruction in a radiated breast, complication rates are higher. Autologous reconstruction is the preferred reconstructive options in the setting of radiation. Another reason women may choose autologous reconstruction over implants is patient preference.


Autologous reconstruction does require more of an investment of time and recovery upfront. Autologous reconstruction necessitates a longer surgery (approximately 6-10 hours), a longer hospital stay (average 3-4 days), and recovery time (6 weeks). The risks of the surgery include need for a take back to the operating room if there are any issues with the microvascular reconstruction. The advantage of using your own tissue is that you are less likely to develop issues years later that could arise with implants. Autologous reconstruction invests more time upfront for a potential longer lasting reconstruction.