Cancer Treatment Centers of America

Breast Reconstruction

Breast Reconstruction

Our program

The breast reconstruction clinicians at Cancer Treatment Centers of America® (CTCA) recognize that treating breast cancer patients involves more than removing the tumor. Breast cancer treatments often change how patients look, feel and function. The decision to have breast reconstruction surgery is extremely personal. For many women, restoring the appearance of one or both breasts may benefit their physical and emotional recovery.

You may consider breast reconstruction:

  • To improve symmetry if only one of your breasts is affected
  • To help restore confidence in your appearance and sense of femininity
  • If you think reconstruction will give you a sense of wholeness or  psychological well-being

Candidates for breast reconstruction have been:

  • Diagnosed with breast cancer, and underwent or plan to undergo breast conservation surgery, such as partial mastectomy or lumpectomy
  • Diagnosed with breast cancer and had a mastectomy
  • Diagnosed with a genetic mutation and plan to have a prophylactic mastectomy

At CTCA®, our plastic and reconstructive surgeons will discuss your breast reconstruction options before a lumpectomy or mastectomy is performed, when appropriate. This conversation is designed to not only help you make more informed decisions about your care, but to arm your surgical oncologist with information that may be important in helping craft an individualized treatment plan that meets your needs and goals. Our surgeons are experienced at revising and repairing misshapen breasts or breast asymmetry that may result after a mastectomy or breast conservation surgery. Women who seek breast reconstruction typically want a natural-looking breast that is more symmetrical with the unaffected breast.

Overview of breast reconstruction

Breast reconstruction options may include reshaping techniques to reduce defects or improve symmetry; implants-based reconstruction; or microsurgical procedures that use the patient’s own skin and tissue (autologous techniques). Recommendations may vary based on many factors, including the location and size of tumors, body mass index, smoking status and chronic diseases such as diabetes.  

Types of reconstructive surgery include:

Immediate breast reconstruction: When appropriate, some women may choose immediate reconstruction of their breast(s) at the same time as their mastectomy. This is not an option for patients who require radiation.

Advantages Disadvantages
When the breast skin is preserved, it often produces a more natural appearance. Longer hospitalization and recovery times may result when compared to mastectomies performed alone.
It may lead to fewer surgeries. More scarring may result than with a mastectomy alone.
Some patients report a psychological benefit to immediate reconstruction over delaying the procedure.


Staged breast reconstruction:
This option rebuilds the breast in several stages to reduce the risk of complications. Many women who require radiation therapy are advised to have staged breast reconstruction instead of simultaneous reconstruction. Your oncoplastic surgeon may recommend placing an expander or implant in the breast to preserve its shape and retain the breast skin until radiation treatments are completed. Once radiation is complete and the tissue has recovered, the expander/implant used to maintain the shape of the breast is removed and replaced during final reconstruction, either with the patient’s own tissue transplanted from a donor site or a silicone or saline implant. 

Advantages Disadvantages
Allows any needed treatment, such as radiation, to begin after mastectomy. Waiting for reconstruction requires patients to live for a time without breasts, which may lead to self-image challenges.
Staging the surgery allows radiated tissue to heal. Multiple procedures raise the risk of infection.
Using an expander, the surgeon is able to create a pocket to provide support for an implant. Performing the surgeries in stages extends the total time needed for total reconstruction.
It is better to have expanders exposed to bacteria that may potentially form after a mastectomy than implants, as the expanders will be permanently removed.


Delayed breast reconstruction:
This is when surgical reconstruction is performed weeks, months or years after the mastectomy. Unlike staged reconstruction, delayed reconstruction is not specifically planned out at the time of a mastectomy or lumpectomy. Patients may opt for delayed reconstruction if their plastic surgeon was not involved with the mastectomy or if they needed radiation treatment after surgery.

Advantages Disadvantages
Patients have more time to consider their options. Waiting for reconstruction requires patients to live for a time without breasts, which may lead to self-image challenges.
Additional cancer therapies performed after mastectomy (such as radiation) do not affect the reconstruction. Delaying the procedure extends the total time needed to complete reconstruction.
Waiting for reconstruction may lead to less optimal cosmetic results, depending on the amount of time between procedures.

During the breast cancer treatment planning process, a plastic surgeon will discuss your medical needs and goals. Your care team will recommend a comprehensive treatment plan designed to meet those goals, while also helping you manage cancer-related side effects, such as lymphedema, hair loss, nausea and pain.

Implant-based reconstruction

A common breast reconstruction procedure involves the use of saline or silicone implants. This option often occurs in two stages. The first includes inserting a tissue expander. The second stage involves removing the tissue expanders and inserting a soft permanent implant.

Oncoplastic reconstruction

As part of a lumpectomy or partial mastectomy procedure, various plastic surgical techniques may be used to reshape the breast and create symmetry after the cancer is removed. Oncoplastic surgery combines the principles of plastic surgery with breast surgical oncology to achieve an optimal aesthetic result. Oncoplastic reconstruction may be recommended for patients who have sufficient breast tissue after cancer removal surgery without the use of implants or tissue transfers.

Oncoplastic reconstruction techniques include:

Corrective surgery repairs: Patients who experienced an unsatisfactory breast reconstruction that resulted in an abnormal breast appearance following a mastectomy may choose corrective surgery to restore the breast to a more natural look.

Skin-sparing mastectomy: This technique involves removing breast tissue while preserving the outer skin. This less-invasive approach to a mastectomy helps preserve the natural contour and shape of the breast while reducing the risk of scarring. Reconstruction options following a skin-sparing mastectomy include silicon or saline implants and autologous fat grafting or tissue transfer. While both procedures use the body’s own cells to reform the breast, fat grafting techniques transfer fat cells from other areas of the body, while tissue transfers transplant tissue from the abdomen, back, buttocks and other regions.

Nipple-sparing mastectomy: This procedure preserves all the skin of the breast, including the nipple and areola, while removing nearly all the inner tissue of the breast. Unlike a traditional mastectomy, it preserves a thin layer of fat and blood vessels that are needed to maintain adequate blood flow and protect the skin’s viability. Since most of the nerves to the skin are removed during the mastectomy, the preserved skin and nipple often become permanently numb. A nipple-sparing mastectomy, combined with immediate breast reconstruction, may produce a reconstructed breast that looks similar to the original breast, with the skin and nipple intact.

3-D nipple tattoo: Instead of using tissue to rebuild a nipple, some women choose to have a nipple tattooed on the reconstructed breast. Many 3-D nipple tattoos provide realistic results by darkening, contouring and shading the nipple area to match the opposite breast.

Autologous reconstruction

Compared to implant-based reconstruction, autologous procedures typically require more time and a longer recovery period. But because they take advantage of the patient’s own tissue, these techniques may yield more natural results. The tissue and skin may be transplanted from various areas of the patient’s body, and the area and method chosen will depend on the amount and quality of tissue available.

The tissue (called a "flap") usually comes from the belly, the back, buttocks, or inner thighs to create the reconstructed breast. Autologous breast reconstruction techniques are classified based on the composition of the flaps and the source of the tissue. CTCA offers a wide array of tissue transfer procedures, including:

Deep inferior epigastric artery perforator (DIEP) flap surgery:This microsurgical procedure moves fat, skin and the blood supply from the lower belly to the breast.

Stacked DIEP flap reconstruction: A newer approach to DIEP, this procedure is used to reconstruct one breast in women who don’t have adequate extra belly tissue and are therefore ineligible for standard DIEP surgery.

Transverse rectus abdominis myocutaneous (TRAM) flap surgery: This operation also uses abdominal tissue and is typically shorter in duration than the DIEP flap surgery. It is performed less often because it affects the core abdominal muscles.

Superficial inferior epigastric artery (SIEA) flap: An alternative free-flap procedure, this technique uses the skin and fat of the lower abdomen. In an SIEA flap, incisions are made in the skin and fat only, allowing the flap to be transferred based on the superficial inferior epigastric vessels. This often results in less post-operative pain and lower risk of herniation.

Transverse upper gracilis (TUG) flap: This procedure uses the gracilis muscle, located in the upper inner thigh, starting at the pubic bone and ending along the inside of the upper leg. You use the gracilis muscle to bring your leg toward your body. Patients who undergo TUG flap surgery are no longer able to use this muscle.

Superior gluteal artery perforator flap (SGAP) and inferior gluteal artery perforator flap (IGAP) flap: For patients who do not have sufficient tissue in the abdomen or thigh, the gluteal region, or buttock, may also be used to create a flap. The SGAP flap uses the upper portion of the buttock, while the IGAP flap uses the lower portion. 

Rubens free flap: This procedure uses the fatty area in the region near the hip. This tissue may be harvested in a patient who has undergone an abdominoplasty or a TRAM flap in the past.

Latissimus dorsi flap: This procedure uses muscle, skin and fat from the back. Similar to implant reconstruction, it is performed in two stages.

Autologous fat grafting: This technique uses liposuction to remove fat from one area of the body, such as the belly, and transfers it to the breast, allowing surgeons to fine-tune the breast’s shape. Fat is a rich source of stem cells, which are critical to healing. Transferring fat may help nurture the formation of new blood vessels, improve skin texture and, in some cases, restore some lost sensation.

Breast reconstruction at Southwestern

Plastic Surgeon Dr. Rola Eid leads the breast reconstruction program at CTCA at Southwestern Regional Medical Center (Southwestern). Dr. Eid and Surgical Oncologist Dr. Huan Vu work collaboratively on the details of each patient’s surgical care plan. Dr. Eid offers a variety of techniques to help restore the appearance of the breast and nipple area.

Because changes to your body may raise concerns about sexuality and femininity, your care team may include clinicians who offer evidence-based supportive therapies. The mind-body therapists, oncology rehabilitation providers, licensed dietitians and spiritual counselors can offer advice, resources and therapies to support your overall well-being. 

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