The Mastectomy Surgery

While there are many options available in post-mastectomy reconstruction, you and your surgeon should discuss the one that's best for you.

Skin expansion. The most common technique combines skin expansion and subsequent insertion of an implant.

A tissue expander is inserted following
the mastectomy to prepare for

        Following mastectomy, your surgeon will insert a balloon expander beneath your skin and chest muscle. Through a tiny valve mechanism buried beneath the skin, he or she will periodically inject a salt-water solution to gradually fill the expander over several weeks or months. After the skin over the breast area has stretched enough, the expander may be removed in a second operation and a more permanent implant will be inserted. Some expanders are designed to be left in place as the final implant. The nipple and the dark skin surrounding it, called the areola, are reconstructed in a subsequent procedure.


The expander is gradually filled with
saline through an integrated or separate
tube to stretch the skin enough to
accept an implant beneath the chest

Some patients do not require preliminary tissue expansion before receiving an implant. For these women, the surgeon will proceed with inserting an implant as the first step.

                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.

Flap reconstruction. An alternative approach to post-mastectomy implant reconstruction involves creation of a skin flap using tissue taken from other parts of the body, such as the back, abdomen, or buttocks.

In one type of flap surgery, the tissue remains attached to its original site, retaining its blood supply. The flap, consisting of the skin, fat, and muscle with its blood supply, are tunneled beneath the skin to the chest, creating a pocket for an implant or, in some cases, creating the breast mound itself, without need for an implant.

With flap surgery, tissue is taken from
the back and tunneled to the front of the
chest wall to support the reconstructed

Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and then transplanted to the chest by reconnecting the blood vessels to new ones in that region. This procedure requires the skills of a plastic surgeon who is experienced in microvascular surgery as well.

The transported tissue forms a flap for
a breast implant, or it may provide
enough bulk to form the breast mound
without an implant.

Regardless of whether the tissue is tunneled beneath the skin on a pedicle or transplanted to the chest as a microvascular flap, this type of surgery is more complex than skin expansion. Scars will be left at both the tissue donor site and at the reconstructed breast, and recovery will take longer than with an implant. On the other hand, when the breast is reconstructed entirely with your own tissue, the results are generally more natural and there are no concerns about a silicone implant. In some cases, you may have the added benefit of a improved abdominal contour.


Tissue may be taken from the abdomen
and tunneled to the breast or surgically
transplanted to form a new breast mound.

Follow-up procedures. Most breast reconstruction involves a series of procedures that occur over time. Usually, the initial reconstructive operation is the most complex. Follow-up surgery may be required to replace a tissue expander with an implant or to reconstruct the nipple and the areola. Many surgeons recommend an additional operation to enlarge, reduce, or lift the natural breast to match the reconstructed breast. But keep in mind, this procedure may leave scars on an otherwise normal breast and may not be covered by insurance.


                After surgery, the breast mound, nipple,
                and areola are restored.


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