Breast Reconstruction

Breast reconstruction surgery rebuilds all or part of a breast after lumpectomy, mastectomy, or due to other factors, such as congenital differences, traumatic injury, or another surgery. Many people choose reconstruction after breast cancer treatment. Others choose it after surgery to prevent breast cancer because of genetic risk.

Reconstruction is a personal choice. Some people want to restore or modify breast shape. Others decide not to have reconstruction at all or want an aesthetic flat closure. There is no right or wrong decision — only what feels right for you.

At UVA Health, our plastic surgeons work closely with your cancer care team. Together, we help you understand your options and create a plan that fits your goals, your health, and your treatment timeline.

When Is Breast Reconstruction Done?

Breast reconstruction can happen at different times.

Immediate Reconstruction

Your surgeon rebuilds the breast during the same operation as your cancer removal. This allows for one surgery and one recovery period.

When breast reconstruction is done immediately after a lumpectomy, your plastic surgeon will rearrange the remaining breast tissue and optimize the breast shape, typically by performing a breast lift or a breast reduction. This is often accompanied by a similar procedure on the other side. This approach is often oncoplastic breast surgery.

When breast reconstruction is performed immediately following a mastectomy, your plastic surgeon will rebuild the breast shape using either a tissue expander, implant, or tissue flap.

Benefits of Immediate Breast Reconstruction

• Preserving the skin and breast shape
• A psychological sense of wholeness following surgery
• Fewer surgeries

Downsides of Immediate Breast Reconstruction

• Longer surgery duration
• Potential complications
• Additional complexity

About 50-75% of patients that get breast reconstruction after mastectomy get immediate reconstruction. This number has been increasing over the past 20 years.

Delayed Reconstruction

Some patients may not be ready to undergo reconstruction and choose to delay it for months or years after breast cancer treatment ends.

Impacts of Radiation & Chemotherapy

Chemotherapy and radiation can impact the type of reconstruction options you have.

Radiation can damage the breast skin, which makes implant reconstruction challenging. If you are undergoing chemotherapy or radiation therapy, your plastic surgeon will help you determine the best timing and option for you.

Types of Breast Reconstruction

There are several common ways to perform breast reconstruction. The main types of breast reconstruction use either implants or your own tissue to rebuild the breast.

Implant Reconstruction

Implant reconstruction uses breast implants filled with silicone or saline to replace and mimic your natural breast size and shape. Silicone breast implants are commonly used in cosmetic breast augmentation and are the most commonly used method for breast cancer reconstruction.

In many cases, a tissue expander is placed first (at the time of mastectomy) to act as a temporary space filler and allow breast skin to expand gradually. Later, the expander is replaced with a permanent implant.

In some cases, your plastic surgeon will replace the breast tissue with a silicone or saline implant at the same time as your mastectomy. The breast skin must be well vascularized and healthy. Because implants can’t be adjusted after surgery, this approach also limits the option to adjust size.

You may prefer implant reconstruction if you want:
• A shorter initial surgery and hospital stay
• No surgery on other parts of your body

Things to consider:
• It often requires more than one procedure.
• Implants may not feel as natural as your own tissue and may not match the natural breast on the other side.
• Implants may develop scar tissue around them (capsule) and typically need replacement every 10 years.

Fat Grafting Breast Reconstruction With Implants

Fat grafting is often used to add padding over top and around breast implants after reconstruction. Fat grafting uses liposuction to transfer fat from another part of your body to your breast area.

Breast Reconstruction Using Your Tissue (Autologous/Flap)

Autologous breast reconstruction uses your own skin, fat, blood vessels, and sometimes muscle from other parts of your body to create a breast mound that has a more natural look and feel than implants. Also called flap surgery, it can be done:

• Immediately after the mastectomy or months after placement of a tissue expander
• Many years after the mastectomy (delayed reconstruction)
• In women who had radiation as part of their cancer care
• To replace implants that aren’t working well

There are several kinds of flap procedures.

The DIEP flap is the most common type and takes skin and fat from the lower abdomen to rebuild the breast. Surgeons connect blood vessels from the flap to your chest using microsurgery to bring circulation to the tissue. This option preserves your abdominal muscles and can create a very natural look and feel.

DIEP flap reconstruction at UVA Health has a 98-99% success rate. As part of your breast cancer team, we meet with you regularly after your surgery in-person or through telehealth to make sure you’re healing well.

Other types of tissue flaps we offer include TUG, DUG, VUG, PAP, lumbar, SIEA, and GAP flaps. These also require transfer of blood vessels to deliver tissue from one area of the body to the breast.

We sometimes use the latissimus dorsi flap when other options aren’t available. It uses muscle and skin from your upper back. It’s sometimes combined with an implant for added volume.

You may prefer flap reconstruction if you want:
• A more natural look and feel, especially to match a natural breast on the other side
• No implants
• Long-lasting results

Things to consider:
• Longer surgery and recovery
• Scars at the donor site
• A longer hospital stay

Your surgeon will review your anatomy, treatment history, and goals to help guide this decision.

Fat Grafting

Fat grafting may be used alone in some cases or to refine other reconstruction results.

During fat grafting, surgeons remove fat from another area of your body using liposuction. They purify it and inject it into the breast to improve shape and softness.

Fat grafting can:
• Smooth contour irregularities
• Improve symmetry
• Enhance implant reconstruction results

Some of the transferred fat is naturally absorbed. You may need more than one session for optimal results.

Bringing Back Sensation & Nipple Reconstruction

It’s common to lose feeling after a mastectomy. Our plastic surgeons use advanced microsurgery to repair nerves whenever possible.

Nipple & Areola Reconstruction

After your breast has healed, you may choose nipple reconstruction. Surgeons create a small raised nipple using skin from your reconstructed breast.

You can also choose medical tattooing to recreate the areola and add realistic color and detail. Some people choose tattooing alone. Others combine both options.

Nipple reconstruction is optional. Many people are happy without it.

What to Expect After Reconstruction Surgery

Recovery depends on the type of reconstruction you have.

Implant reconstruction recovery usually takes about 3 to 4 weeks.

Flap reconstruction recovery often takes 4 to 6 weeks or longer.

You can expect:
• Swelling and bruising during the first few weeks
• Surgical drains for 1 to 2 weeks
• Activity restrictions during early healing

Your care team will give you clear instructions about:
• Pain control
• Incision care
• Wearing a surgical bra
• When to return to work and exercise

Enhanced Recovery After Surgery (ERAS)

We’ve helped develop approaches that make surgery easier on your body. For breast flap procedures, we use a program called ERAS to help you leave the hospital sooner, recover faster, and rely less on strong pain medications. We also use a variety of nerve blocks to help reduce pain after surgery.

Risks of Breast Reconstruction Surgery

All surgery carries risk. Possible complications include:

• Infection
• Bleeding
• Fluid buildup
• Delayed wound healing
• Implant-related problems
• Partial or total flap failure (rare)

We will review your medical history carefully and discuss risks based on your specific situation.

Is Breast Reconstruction Right for Me?

You may consider reconstruction if you:

• Have had or plan to have a mastectomy
• Want to restore breast shape
• Are healthy enough for surgery
• Have realistic expectations

This is a deeply personal decision. Some people feel reconstruction helps them move forward. Others feel whole without it. Both choices are valid.

Our role is to give you clear information, answer your questions, and support whatever decision feels right for you.