Navigating Your Journey: Breast Reconstruction Options After Mastectomy

Facing a mastectomy is undoubtedly one of life’s most challenging experiences. The emotional and physical impact that breast cancer and mastectomy can have on a person’s sense of self is profound. At the plastic surgery office of Dr. Aviva Preminger in New York City, breast reconstruction is viewed as far more than a cosmetic procedure—it’s considered an essential step in the healing journey for many women.

Understanding Your Right to Reconstruction

Before exploring options, it’s important to know that the Women’s Health and Cancer Rights Act of 1998 guarantees insurance coverage for breast reconstruction following a mastectomy. This applies to all stages of reconstruction, including procedures to achieve symmetry between breasts and nipple reconstruction if desired.

The Timing Question: Immediate vs. Delayed Reconstruction

One of the first decisions to make regarding breast reconstruction is timing:

Immediate Reconstruction

• Begins during the same surgery as the mastectomy
• Allows patients to wake up with a breast mound already in place
• May provide psychological benefits by reducing the sense of loss
• Often achieves better cosmetic results as it preserves the natural breast skin envelope

Delayed Reconstruction

• Performed months or even years after mastectomy
• Gives time to focus on cancer treatments first
• Provides space to carefully consider all reconstruction options
• May be recommended if radiation therapy is part of the treatment plan

Neither choice is inherently better than the other—the right timing depends on unique circumstances, medical needs, and personal preferences.

Reconstruction Options: Finding the Right Fit

Every woman’s body, preferences, and medical situation are different. Dr. Preminger takes pride in offering personalized consultations that carefully consider all factors before recommending a reconstruction approach. Here are the main options available:

Implant-Based Reconstruction

Implant reconstruction is the most common approach and typically involves a two-stage process:

Stage One: Tissue Expansion

• A temporary expandable implant (tissue expander) is placed beneath the chest muscle or skin
• Over several weeks, the expander is gradually filled with saline during office visits
• This gentle process allows skin and tissue to stretch, creating space for the permanent implant

Stage Two: Permanent Implant Placement

• Once expansion is complete, a second surgery replaces the expander with a permanent implant
• Options include silicone gel implants (which offer a more natural feel) or saline implants
• The latest cohesive gel “gummy bear” implants maintain their shape better than earlier generations

Pre-Pectoral Implant Placement

For suitable candidates, Dr. Preminger offers the advanced technique of placing implants above rather than beneath the chest muscle. This approach:

• Creates a more natural look and movement
• Eliminates animation deformity (visible implant movement during muscle contraction)
• Typically results in less post-operative pain
• Requires adequate thickness of skin flaps after mastectomy

Benefits of Implant Reconstruction:

• Shorter surgery and recovery time compared to flap procedures
• No donor site incisions or scars on other parts of the body
• Less invasive procedure overall

Considerations:

• May require replacement over time
• Can develop capsular contracture (hardening of scar tissue around implant)
• May not match the natural aging process of remaining breast tissue

Autologous (Flap) Reconstruction

Flap procedures use the patient’s own tissue transplanted from another part of the body to recreate the breast. This approach creates breasts that look and feel more natural and that age with the body over time.

DIEP Flap (Deep Inferior Epigastric Perforator)

• Uses skin, fat, and blood vessels from the lower abdomen
• Preserves abdominal muscles, maintaining core strength
• Results in a flatter abdomen (similar to a tummy tuck)
• Typically creates the most natural-looking and feeling breast

TRAM Flap (Transverse Rectus Abdominis Myocutaneous)

• Similar to DIEP but includes abdominal muscle
• Generally provides robust blood supply to the flap
• May result in some abdominal weakness
• Less commonly used now that muscle-sparing techniques have advanced

Latissimus Dorsi Flap

• Uses muscle, skin, and fat from the upper back
• Often combined with an implant for additional volume
• Good option for women with insufficient abdominal tissue
• Results in a scar on the back, usually hidden by a bra strap

Other Flap Options

• PAP flap (from posterior thigh)
• SGAP/IGAP flaps (from buttocks)
• TUG flap (from inner thigh)
• These alternative donor sites are considered when abdominal tissue isn’t available

Benefits of Autologous Reconstruction:

• Creates a more natural look and feel that ages with the body
• No risk of implant complications like rupture or contracture
• Often provides lifelong results without need for replacement
• Removes tissue from another area that may have excess (like abdomen)

Considerations:

• Longer, more complex surgery
• Extended recovery time (typically 6-8 weeks)
• Requires adequate donor tissue
• Creates additional scars at the donor site

Fat Grafting: Enhancing Results

Fat grafting has revolutionized breast reconstruction, whether used alone for small defects or as a complementary technique:

• Involves liposuction to harvest fat from areas like abdomen, thighs, or flanks
• Processed fat is carefully injected to improve contour and add volume
• Can soften the appearance of implants and create more natural transitions
• May require multiple sessions for optimal results
• Particularly useful for correcting irregularities after other reconstruction methods

Nipple and Areola Reconstruction

The final phase of breast reconstruction typically involves recreating the nipple and areola:

Nipple Reconstruction

• Usually performed as a separate, minor outpatient procedure
• Uses small flaps of skin from the reconstructed breast mound
• Creates a projecting nipple that matches the opposite side

Areola Reconstruction

• Can be created through medical tattooing or skin grafting
• Tattooing can precisely match the color of the natural areola
• 3D tattooing techniques create the appearance of texture and projection

Some women opt for nipple-sparing mastectomy when oncologically appropriate, which preserves the natural nipple and areola.

Aesthetic Flat Closure: A Valid Choice

Not every woman chooses reconstruction after mastectomy. Aesthetic flat closure is a legitimate option that:

• Removes excess skin and contours the chest wall for a smooth, flat appearance
• Minimizes scarring and optimizes aesthetics
• Doesn’t require ongoing procedures or monitoring
• May be the best choice for women with certain health considerations or personal preferences

At Dr. Preminger’s practice, each woman’s unique journey is respected without pressure toward reconstruction if that’s not their preference.

The Decision-Making Process: What’s Right for You?

When helping patients decide on a reconstruction path, several factors are considered:

Medical Considerations

• Cancer stage and treatments (especially radiation)
• Body type and available donor tissue
• Overall health and ability to tolerate surgery
• Presence of other medical conditions

Personal Preferences

• Desired recovery time
• Comfort with additional surgical sites
• Importance of natural look and feel
• Long-term maintenance concerns

Lifestyle Factors

• Physical activity levels and impact on recovery
• Professional and personal demands during recovery
• Individual expectations for breast appearance

Frequently Asked Questions About Breast Reconstruction

• How many surgeries will I need for breast reconstruction? Most reconstruction approaches require 2-3 surgeries, including the initial reconstruction, revision procedures (if needed), and nipple reconstruction. The exact number varies based on the chosen technique and individual healing process.
• Will reconstructed breast(s) look and feel exactly like natural breast(s)? While reconstruction techniques have advanced significantly, reconstructed breasts won’t be identical to natural breasts. However, modern approaches can create very natural-looking results that look appropriate in clothing and swimwear.
• How long is recovery from breast reconstruction? Recovery varies by procedure. Implant reconstruction typically requires 2-3 weeks before returning to normal activities, while flap procedures generally require 6-8 weeks. Complete healing continues for several months.
• Can cancer recurrence occur in a reconstructed breast? Breast reconstruction doesn’t increase cancer recurrence risk or interfere with cancer detection. Follow-up screenings will continue as recommended by the oncologist.
• What if a patient isn’t ready to decide about reconstruction yet? It’s perfectly acceptable to delay the decision. Many women successfully undergo reconstruction months or years after mastectomy with excellent results.

Your Breast Reconstruction Journey in NYC

Dr. Aviva Preminger is a board-certified plastic surgeon specializing in breast reconstruction. Her approach combines surgical expertise with compassionate care, ensuring that each patient receives personalized attention throughout the reconstruction process. From the initial consultation through the final follow-up, Dr. Preminger and her team are committed to providing support, answering questions, and helping patients achieve results that allow them to move forward with confidence.

Whether planning ahead for a scheduled mastectomy or considering reconstruction years after breast cancer surgery, schedule a consultation at Dr. Preminger’s Upper East Side Manhattan office. Together with Dr. Preminger, patients can explore options, address concerns, and develop a reconstruction plan that aligns with their goals and lifestyle.

Breast reconstruction is a deeply personal journey, and there’s no universal “right” approach. The best reconstruction is one that meets individual needs, helps patients feel comfortable in their bodies again, and supports emotional healing after breast cancer.

To schedule a private consultation or learn more about breast reconstruction options, contact Dr. Preminger’s office today at (212) 706-1900.