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There are several types of breast reconstruction that can rebuild the shape and look of your breast after cancer surgery. You and your healthcare team will work together to decide the best type for you. This will depend on your health, your personal preferences, and other medical and personal factors.

Before you make your decision, take the time to learn about all your options. Also consider talking to others who had the same type of reconstruction surgery.

Types of breast reconstruction

There are 2 main types of reconstruction.

• Implant reconstruction uses a saline or silicone implant to rebuild your breast.
• Tissue (flap) reconstruction uses tissue from another part of your body.

In some cases, these approaches are combined to rebuild the breast.

You might be able to have reconstruction at the same time as your breast cancer surgery (immediate), or you might need to wait until later (delayed). Both implant and tissue flap reconstruction can be done in either of these ways.

Breast reconstruction often involves more than one surgery.

After the main reconstruction, you might have additional touch-up procedures to improve the look and feel of the breast. These can include fat grafting or scar revision. Your nipple and areola can also be recreated with a small procedure, medical tattooing, or both.

Choosing which type of reconstruction to have

You and your healthcare team will have many things to think about as you decide what type of reconstruction is best for you.

Some things that might affect your choice include:

• Your overall health, including anything that might affect your healing
• The size and location of your breast cancer
• The type and extent of breast cancer surgery you need
• Whether you are having one or both breasts removed
• Whether you need other cancer treatments, such as radiation

You might also need to consider:

• Your current breast size and the size you would like to be after surgery
• Whether you want reconstruction on one or both breasts, and your desire to match the other breast
• Your insurance coverage and related costs for the unaffected breast
• How quickly you want to recover from surgery
• Your willingness to have more than one surgery as part of the reconstruction
• How different types of reconstructive surgery might affect other parts of your body

The amount of tissue available for reconstruction can also affect your choices. If you are very thin, you might not have enough extra abdominal (belly) tissue to use this area for breast reconstruction. Also, if you had a "tummy tuck" in the past, your abdominal tissue is not usable for breast reconstruction.

Your surgeon will review your medical history and overall health. They will explain which options might be best for you based on your age, health, body type, lifestyle, goals, and other factors.

Talk with your surgeon openly about your preferences so that they can be better equipped to help you reach your goals. Voice any of your concerns and priorities for the reconstruction and find a surgeon you feel comfortable with. Your surgeon should explain the limits, risks, and benefits of each option.

Fat grafting

Fat grafting is often used as a follow-up or touch-up after breast reconstruction. This procedure uses your own fat to improve the shape of your reconstructed breast and smooth out uneven areas. Unlike flap surgery, the fat is taken without skin or muscle.

During this procedure:

• Fat is removed using liposuction.
• The fat is cleaned and prepared.
• It is then injected into areas that need more fullness or a smoother shape.

This is usually done as an outpatient procedure, so you can go home the same day. You may need more than one session to get the best result.

Studies show that fat grafting is safe and does not increase the risk of cancer coming back after a mastectomy.

Reconstruction after breast-conserving surgery

Breast-conserving surgery does not remove your entire breast, and many people can keep their nipples. Most people do not need breast reconstruction after this surgery. However, some people might end up with a change in the shape or appearance of their breast. For example, removing a large tumor from a small breast can cause dimpling.

Some doctors combine cancer surgery and plastic surgery techniques to address this type of problem. This is known as oncoplastic surgery. It can often be done at the same time as your breast cancer surgery without the need for more operations.

One or more methods might be used to get the best results:

• Breast lift (mastopexy)
• Breast reduction (reduction mammaplasty)
• Tissue flaps from areas close by, like the back