The goal of breast reconstruction is to create a soft, natural looking breast for a woman who must undergo breast removal due to cancer or other disease. Whether it is performed immediately following mastectomy or at a later time, breast reconstruction can dramatically improve a woman's appearance, self-confidence and overall quality of life.

Figure A. A tissue expander is inserted following the mastectomy to prepare for reconstruction.		Figure B. The expander is gradually filled with saline through an integrated or separate valve to stretch the skin enough to accept an implant beneath the chest muscle.		Figure C. After surgery, the breast mound is restored. Scars are permanent, but will fade with time. The nipple and areola are reconstructed at a later date.

How is breast reconstruction performed?

There are many options available in breast reconstruction. Your anatomy, and your desired results will help determine which method is best for you.

Figure D. The transported tissue forms a flap for a breast implant or it may provide enough bulk to form the breast mound without an implant.		Figure E. Tissue may be taken from the abdomen and tunneled to the breast or surgically transplanted to form a new breast mound.		Figure F. After surgery, the breast mound, nipple and areola are restored.

Skin expansion with a breast implant:

This is the most common method of reconstructing a breast. Following mastectomy, a balloon expander is inserted beneath the skin and chest muscle. (See Figure A.) Over several weeks, the expander balloon is gradually filled with a salt-water solution in the doctor's office, causing the overlying skin to stretch. (See Figure B.) When the skin has stretched sufficiently, the expander is surgically replaced with a more permanent and softer implant. The nipple and the skin surrounding it, called the areola, are reconstructed in a later procedure and utilizing existing scars. (See Figure C.) In rare cases, when a sufficient amount of skin is available, an implant can be placed without the preliminary skin-expansion step.

Flap reconstruction:

Although flap reconstruction is more involved at the initial procedure than reconstruction with an implant, many women prefer it because it may allow the breast to be reconstructed with natural tissue. Also, unlike the tissue expander method, the breast mound is completed at the initial operation, without the need for expansion over an extended time period.

In one method, the breast is reconstructed using a tissue flap - consisting of a portion of skin, fat and muscle - that is taken from the back, or abdomen. (See Figure D.) The flap, still tethered to its original blood supply, is tunneled beneath the skin to the front of the chest wall. (See Figure E.) The transported tissue may be bulky enough to create a new breast mound itself. However, sometimes an implant will be inserted as well.

All of these procedures have advantages and disadvantages, and many times the choice of procedures is limited by other health factors, such as weight, other medical conditions and previous cancer therapy.

Follow-up procedures:

Once the breast mound is restored in the initial procedure, one or more follow-up procedures will be performed to replace a tissue expander with a permanent implant or to construct the nipple and areola. (See Figure F.) The nipple/areola reconstruction can be a simple out-patient/office procedure. The areola is reconstructed by tattooing the pigments to better match the opposite breast.