Restoration of the breast following mastectomy has become an integral part of the holistic treatment of breast cancer. It is the rare individual who cannot take advantage of ever improving techniques of breast reconstruction to offset the impact of the loss of a breast. Many women are able to have reconstruction simultaneous with mastectomy, though it can be done at a later date as a separate operation depending on a variety of factors. These may include the type and size of tumor, the possible need for post-operative radiation therapy or chemotherapy, or the women’s wishes, desires and goals. These decisions are made by the woman in consultation with her surgeon, oncologist and plastic surgeon.

The restoration of the breast is usually done in stages and is accomplished in one of several ways depending on the women’s general health, body and breast size and shape, and the patient’s vision of what she hopes to achieve as an ultimate aesthetic outcome. In patients who have already had a mastectomy and are seeking a secondary reconstruction, the condition, softness, thickness, texture and pliability of the skin become important features in the selection of what method of reconstruction is most suitable.

Inpatient Facilities

Requesting an Inpatient Consultation

215-662-2096 (Bartlett)
215-829-6320 (Bucky)
215-662-4283 (Chang)
215-662-2044 (LaRossa)
215-662-2040 (Low)
215-662-3743 (Serletti)
215-662-2042 (Wu)

Office Visit Locations

10 Penn Tower
PENN Medicine at Radnor
230 W. Washington Square

Making an Office Visit Appointment

800-234-PENN (HUP)
610 -902-2400 (Radnor)
215-829-6320 (PAH)

The surgeon’s goal is to match the natural appearance of the remaining breast in shape, texture and symmetry using one of the several techniques that are currently available. The methods used fall into two general types: implant type reconstructions and those using the patient’s own tissues.

Implant Type Restorations
An implant of silicone filled with silicone gel or saline (IV solution) or a combination of both is placed beneath the skin and pectoral muscle to recreate the breast. Some surgeons prefer to first use a tissue expander (a silicone balloon) to gradually stretch the skin over a period of weeks or months followed by replacement with a breast implant at a second operation.

Restorations with the Woman's Own Tissue
The breast can be recreated using tissue from the abdomen, back, buttock or upper thigh. The most common of these is the abdominal source, the so-called T.R.A.M. flap. In this operation, the area of skin and fat around and below the umbilicus is moved to the site where the breast has been removed. It is sculptured to resemble the remaining breast or into two breasts when a double mastectomy has been done. Removal of the tissue from the abdomen creates a 'tummy-tuck' effect. In some women who are having an immediate reconstruction, the added benefit of a skin-sparing mastectomy may be used. When the conditions are right, as when a small, centrally located, low risk tumor is present, virtually all of the breast skin can be saved (spared) except for the nipple and aerola. The T.R.A.M. flap tissue is used to refill the breast skin envelope yielding a more natural restoration.

Less commonly, tissue can be moved from the back using the latissumus dorsi muscle. Although the skin and muscle may be sufficient to reproduce a small breast, in most instances an implant is needed to restore a larger one.

Finally, soft issues can be borrowed from the buttock or thigh using microsurgery. These represent the most sophisticated and complex methods and are generally reserved for specific indications.

Restoration of Symmetry
Many women wish to have a nipple aerola reconstruction to make their new breast look as normal as possible. Others may benefit from taking the remaining breast smaller, larger or reshaping it to match the reconstructed one. These procedures are usually done several months after restoration of the breast mound.

The techniques of breast reconstruction vary in their complexity, risk, incidence of complications, length of surgery and length of time for recovery. Each woman should review these issues with her plastic surgeon so that the most appropriate method can be chosen. However, it is only under unusual circumstances that a woman cannot restore her sense of wholeness through breast reconstruction.