Home » Breast Cancer » Breast Reconstruction After Mastectomy

Breast Reconstruction After Mastectomy

A mastectomy is a surgical procedure involving removal of all or part of the breast.  Mastectomy classifies into partial, simple, modified-radical, and radical. Other variations in terminology or technique include skin-sparing mastectomy and nipple-areolar sparing mastectomy, which are techniques that often accompany breast reconstruction. 

Breast Reconstruction After Mastectomy

Source: National Cancer Institute

What is breast reconstruction?

Many women who have a mastectomy—surgery to remove an entire breast to treat or prevent breast cancer—have the option of having the shape of the removed breast rebuilt.

Women who choose to have their breasts rebuilt have several options for how it can be done. Breasts can be rebuilt using implants (saline or silicone). They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast.

Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction). Delayed reconstruction can happen months or even years after the mastectomy.

In a final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy.

Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape.

How do surgeons use implants to reconstruct a woman’s breast?

Implants are inserted underneath the skin or chest muscle following the mastectomy. (Most mastectomies are performed using a technique called skin-sparing mastectomy, in which much of the breast skin is saved for use in reconstructing the breast.)

Implants are usually placed as part of a two-stage procedure.

In some cases, the implant can be placed in the breast during the same surgery as the mastectomy—that is, a tissue expander is not used to prepare for the implant.

Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or “sling” to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.

How do surgeons use tissue from a woman’s own body to reconstruct the breast?

In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a woman’s body and used to rebuild the breast. This piece of tissue is called a flap.

Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.

Depending on their source, flaps can be pedicled or free.

Abdominal and back flaps include:

Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who don’t have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.

In some cases, an implant and autologous tissue are used together. For example, autologous tissue may be used to cover an implant when there isn’t enough skin and muscle left after mastectomy to allow for expansion and use of an implant (1,2).

How do surgeons reconstruct the nipple and areola?

After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction (1).

Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.

A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts (4,5).

What factors can affect the timing of breast reconstruction?

One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.

Another factor is the type of breast cancer. Women with inflammatory breast cancer usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.

Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.

What factors can affect the choice of breast reconstruction method?

Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the woman’s age and health, her history of past surgeries, surgical risk factors (for example, smoking history and obesity), the availability of autologous tissue, and the location of the tumor in the breast (2,6). Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.

Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.

Reconstruction with Implants

Surgery and recovery

Possible complications

Other considerations

The Food and Drug Administration (FDA) recommends that women with silicone implants undergo periodic MRI screenings to detect possible “silent” rupture of the implants

More information about implants can be found on FDA’s Breast Implants page.

Reconstruction with Autologous Tissue

Surgery and recovery

Possible complications

Other considerations

All women who undergo mastectomy for breast cancer experience varying degrees of breast numbness and loss of sensation (feeling) because nerves that provide sensation to the breast are cut when breast tissue is removed during surgery. However, a woman may regain some sensation as the severed nerves grow and regenerate, and breast surgeons continue to make technical advances that can spare or repair damage to nerves.

Any type of breast reconstruction can fail if healing does not occur properly. In these cases, the implant or flap will have to be removed. If an implant reconstruction fails, a woman can usually have a second reconstruction using an alternative approach.

What type of follow-up care and rehabilitation is needed after breast reconstruction?

Any type of reconstruction increases the number of side effects a woman may experience compared with those after a mastectomy alone. A woman’s medical team will watch her closely for complications, some of which can occur months or even years after surgery (1,2,10).

Women who have either autologous tissue or implant-based reconstruction may benefit from physical therapy to improve or maintain shoulder range of motion or help them recover from weakness experienced at the site from which the donor tissue was taken, such as abdominal weakness (11,12). A physical therapist can help a woman use exercises to regain strength, adjust to new physical limitations, and figure out the safest ways to perform everyday activities.

Does breast reconstruction affect the ability to check for breast cancer recurrence?

Studies have shown that breast reconstruction does not increase the chances of breast cancer coming back or make it harder to check for recurrence with mammography (13).

Women who have one breast removed by mastectomy will still have mammograms of the other breast. Women who have had a skin-sparing mastectomy or who are at high risk of breast cancer recurrence may have mammograms of the reconstructed breast if it was reconstructed using autologous tissue. However, mammograms are generally not performed on breasts that are reconstructed with an implant after mastectomy.

A woman with a breast implant should tell the radiology technician about her implant before she has a mammogram. Special procedures may be necessary to improve the accuracy of the mammogram and to avoid damaging the implant.

More information about mammograms can be found in the NCI fact sheet Mammograms.

What are some new developments in breast reconstruction after mastectomy?

Selected References

Mehrara BJ, Ho AY. Breast Reconstruction. In: Harris JR, Lippman ME, Morrow M, Osborne CK, eds. Diseases of the Breast. 5th ed. Philadelphia: Wolters Kluwer Health; 2014.

Cordeiro PG. Breast reconstruction after surgery for breast cancer. New England Journal of Medicine 2008; 359(15):1590–1601. DOI: 10.1056/NEJMct0802899Exit Disclaimer

Roostaeian J, Pavone L, Da Lio A, et al. Immediate placement of implants in breast reconstruction: patient selection and outcomes. Plastic and Reconstructive Surgery 2011; 127(4):1407-1416. [PubMed Abstract]

Petit JY, Veronesi U, Lohsiriwat V, et al. Nipple-sparing mastectomy—is it worth the risk? Nature Reviews Clinical Oncology 2011; 8(12):742–747. [PubMed Abstract]

Gupta A, Borgen PI. Total skin sparing (nipple sparing) mastectomy: what is the evidence? Surgical Oncology Clinics of North America 2010; 19(3):555–566. [PubMed Abstract]

Schmauss D, Machens HG, Harder Y. Breast reconstruction after mastectomy. Frontiers in Surgery 2016; 2:71-80. [PubMed Abstract]

Jordan SW, Khavanin N, Kim JY. Seroma in prosthetic breast reconstruction. Plastic and Reconstructive Surgery 2016; 137(4):1104-1116. [PubMed Abstract]

Gidengil CA, Predmore Z, Mattke S, van Busum K, Kim B. Breast implant-associated anaplastic large cell lymphoma: a systematic review. Plastic and Reconstructive Surgery 2015; 135(3):713-720. [PubMed Abstract]

U.S. Food and Drug Administration. Anaplastic Large Cell Lymphoma (ALCL). Accessed August 31, 2016.

D’Souza N, Darmanin G, Fedorowicz Z. Immediate versus delayed reconstruction following surgery for breast cancer. Cochrane Database of Systematic Reviews 2011; (7):CD008674. [PubMed Abstract]

Monteiro M. Physical therapy implications following the TRAM procedure. Physical Therapy 1997; 77(7):765-770. [PubMed Abstract]

McAnaw MB, Harris KW. The role of physical therapy in the rehabilitation of patients with mastectomy and breast reconstruction. Breast Disease 2002; 16:163–174. [PubMed Abstract]

Agarwal T, Hultman CS. Impact of radiotherapy and chemotherapy on planning and outcome of breast reconstruction. Breast Disease. 2002;16:37–42. DOI: 10.3233/BD-2002-16107Exit Disclaimer

De La Cruz L, Blankenship SA, Chatterjee A, et al. Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: A systematic literature review. Annals of Surgical Oncology 2016; 23(10):3247-3258. [PubMed Abstract]

Breast Reconstruction in Ireland

The following is taken from the HSE website:

Breast Reconstruction clinic
– University Hospital Limerick

Breast service

Saint Nessan’s Road, Limerick, V94 F858


061 482895  061 482796   061 585351

Contact Person: Clerical Officer

Breast service

Breast services provide multi-disciplinary care to patients with symptomatic breast disease and in particular, to women with breast cancers. Triple Assessment Clinics where patients can be seen by a surgeon, have imaging (mammogram/ultrasound) and biopsy (Fine Needle Aspiration for Cytology) at the same visit.

Breast Reconstruction clinic

Breast Reconstruction is an integral part of breast cancer treatment. At the clinic, the patient will meet with the plastic surgeon. Following an examination, the different suitable options will be discussed and explained. Some operations to make a new breast are less involved than others, and a decision is reached between the surgeon and the patient as to which is best for the individual.

Referrals and Appointments

Who needs to refer you: GP, Consulant, Inter-department within the hospital

Referral Information: Patient personal details. Clinical information or past medical history.

Breast Cancer
Updated 2024

Please share this page to help others