What is breast reconstruction surgery?
Breast reconstruction is an elective procedure after a mastectomy or lumpectomy to treat or prevent breast cancer. The goal of breast reconstruction is to recreate the volume and shape of a breast, so that in clothing no one would know you’ve had a mastectomy. Breast reconstruction after mastectomy can help you feel whole, both physically and emotionally.
Breast reconstruction can happen any time after a mastectomy, even several years later. However, most patients choose to have breast reconstruction right after the mastectomy; this is called immediate reconstruction.
Following diagnosis or treatment of breast cancer, you will have many important decisions to make, including whether to have your breasts reconstructed after breast surgery. Penn Medicine performs a high volume of breast reconstruction procedures, among the most in the nation annually. Our high volume means we are experts in all stages of the breast reconstruction process, from consultation to recovery. We can help you navigate your breast reconstruction options with personalized guidance so you can make an informed decision.
Breast reconstruction options after mastectomy
There are several types of breast reconstruction procedures. Some use breast implants and others use your body’s own tissue. Some procedures use a combination. Penn Medicine offers all options for breast reconstruction after mastectomy, including:
- Implant breast reconstruction (mammoplasty): This is the surgical placement of breast implants to reconstruct the breast size and shape. Breast implants come in a variety of shapes and sizes to create a natural-looking result.
- Free-flap breast reconstruction (autologous tissue reconstruction): This procedure uses tissues from your own body to reconstruct the breasts after mastectomy. Penn Medicine performs the largest volume of free-flap reconstruction surgeries in the United States.
- Deep inferior epigastric perforator (DIEP): This type of free-flap reconstruction uses skin, fat cells, and blood vessels from the lower abdomen to create a natural-looking breast. No abdominal muscles are used, resulting in a shorter recovery time than other methods.
- Hybrid breast reconstruction (composite breast reconstruction): This procedure combines an implant with your own tissues. This approach is less common but is a good choice for some people who had radiation or don't have enough body fat to move to the breast area.
- Tissue expansion: This procedure prepares the skin for breast implants or reconstruction by inserting a silicone balloon expander temporarily in the area that needs repairing. The expander is gradually filled with sterile water over time to stretch and grow the skin.
Who is a candidate for breast reconstruction surgery?
If you’re considering breast reconstruction surgery, your oncologist refers you to our breast reconstruction team for an initial consultation. You can meet with one of our plastic surgeons to discuss your goals and the types of breast reconstruction options available to you. We also discuss the risks, potential complications, and likely outcomes. Together we choose the breast reconstruction surgery procedure that is in line with your health situation and preferences. At the breast reconstruction consultation, we also take specialized images of your chest and arrange your pre-operative workup.
What to expect from the breast reconstruction process
It's important to know that each breast reconstruction journey is different. Our skilled team guides you through your personal breast reconstruction process with compassionate care.
Throughout your journey, you can access expert information through our Penn Breast Reconstruction Advocate (PennBRA) online portal and reach out to your providers through MyChart by myPennMedicine. When you choose which type of breast reconstruction surgery to have, we can pair you with a patient who has had the same kind of surgery. In our Peer-to-Peer Telephone Program you can learn insights about the breast reconstruction process from someone who's been there.
The breast reconstruction surgery process depends on the type of surgery you have and whether you choose an immediate or delayed reconstruction. Some breast reconstruction surgeries are performed years after a mastectomy.
On the day of your breast reconstruction surgery, you will arrive and check in at our facility. We prepare you for surgery, including giving you general anesthesia to keep you comfortable.
Implant reconstruction immediately after a mastectomy usually requires two surgeries several months apart. In the first surgery, your reconstructive plastic surgeon places an expander under the skin of your chest and either under or on top of the chest wall muscles. Your surgeon may insert drains to help remove fluid from the surgical sites. Surgery can take one to two hours. You can expect to be in the hospital for one to two days.
Free-flap breast reconstruction surgery is also a two-part surgery, but the procedures happen on the same day. After your mastectomy, your reconstructive plastic surgeon removes tissues from your lower abdomen, buttocks, or thigh and inserts them into your chest. Your surgeon may insert drains to help remove fluid from the surgical sites. Surgery can take four to eight hours for one side (unilateral) and longer for two sides (bilateral). You can expect to be in the hospital for three days.
After surgery, we move you to an intermediate care floor, a level of care between a regular surgical unit and an intensive care unit. A nurse checks on you every hour for the first 48 hours and then every two hours for the remainder of your hospital stay.
Since Penn Medicine is an academic institution, we have many resident physicians in the hospital at all times. That means, in addition to your plastic surgeon, you have 24/7 access to highly trained experts after surgery.
Breast reconstruction recovery
Before you go home, we teach you how to care for your drains and incisions and take your medications. We also tell you about any activity restrictions. We connect you with Penn Medicine Home Health and our visiting care nurses.
Once you get home, you can continue to rely on Penn Medicine specialists for expert care. We see you for follow-up care frequently, typically at two weeks, three weeks, four weeks, eight weeks, three months, six months, and one year after surgery. During this time, your doctor may recommend physical therapy, and we can connect you to those resources.
You can always reach a Penn Medicine provider by phone, either in the clinic during office hours or the plastic surgery resident on call after clinic hours. You can also send questions at any time through MyChart by myPennMedicine.
For implant reconstruction, including mastectomy and placement of tissue expanders, most patients take four weeks off work. Recovery from the second stage surgery (removal of tissue expanders and placement of the permanent implant) is usually one to two weeks.
For free-flap reconstruction following a mastectomy, patients are typically away from work for six to eight weeks.
When it comes to breast reconstruction, nipple and areola enhancement are typically the final step. After your new breasts have had time to heal, you may consider nipple reconstruction, 3D nipple and areola tattooing (a form of micropigmentation), or both. A plastic surgeon can build a new nipple in an outpatient procedure. The new nipple will not have sensation or react to touch and temperature in the way that a natural nipple would.
Why choose Penn Medicine for breast reconstruction?
If you’re considering breast reconstruction, it’s important to choose a team with diverse experience handling simple to complex situations on a routine basis. You can trust Penn Medicine for:
- Full array of breast reconstruction options: As the nation's highest-volume breast reconstruction program, we offer all options for breast reconstruction surgery. We present options to you, along with the pros and cons of each, so that you can make the best choice for you.
- Latest advancements: As a premier academic institution teaching the next generation of skilled breast surgeons, we continuously develop and learn leading-edge surgical techniques and procedures. Our surgeons are thought leaders who regularly publish research results and train other surgeons, benefiting patients worldwide.
- Advancing microsurgery: Our surgeons have vast experience in microsurgery, also known as free-flap surgery. Microsurgery procedures use tissues from your own body to reconstruct the breasts after mastectomy. We also developed a revolutionary minimally invasive free-flap procedure.
- Nipple and areola enhancement: One option after breast reconstruction is nipple and areola 3D tattooing. We work with micropigmentation specialists who are leaders in their field.
- Re-sensation of the breast: Penn Medicine surgeons are leaders in researching re-innervation of the breast, a procedure that returns breast sensation after mastectomy.
- Modern pain management protocols: We are leaders in procedures that reduce pain using minimal or no narcotics, resulting in a reduced risk of opioid abuse or opioid use disorder. Reduced pain helps our patients go home faster.
- Coordination for care at home: Before you go home, we coordinate home care from Penn Medicine Home Health. Our visiting nurses are experts in post-surgical care. Also, with our telemedicine portal, sometimes you can have post-operative appointments from home.
- Comprehensive education: We ensure you and your family know what to expect before, during, and after breast reconstruction surgery. In addition to individualized guidance from our team, our Penn Breast Reconstruction Advocate (PennBRA) online portal is a unique resource with extensive information about breast reconstruction.
- Peer support from other patients: We match you with a volunteer who experienced the same type of breast reconstruction. You can connect over the phone to share your experiences and get a peer's perspective on your upcoming surgery and recovery process.
Rated “exceptional” by The National Cancer Institute
Penn Medicine’s Abramson Cancer Center is a world leader in cancer research, patient care, and education. Our status as a national leader in cancer care is reflected in our continuous designation as a Comprehensive Cancer Center by the National Cancer Institute (NCI) since 1973, one of 7 such centers in the United States. The ACC is also a member of the National Comprehensive Cancer Network, one of a select few cancer centers in the U.S., that are working to promote equitable access to high-quality, advanced cancer care.
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