Types of Breast Reconstruction Surgery:

Implants

Pros

  • Shorter recovery time
  • Shorter, less complex surgery
  • Only 1 scar
  • Sensation possible with nerve grafting and nerve preservation

Cons

  • Potentially less natural look 
  • Doesn’t age or change with the rest of the body 
  • Must be replaced periodically. Current recommendations are to leave implants in place until any issues arise; surgeons are now expecting something like replacement every ~20-25 years.

Autologous Tissue

Pros

  • Using your own tissue/fat from other areas of your body, so no foreign objects in your body
  • Natural looking
  • Sensation possible with ReSensation 
  • Never have to worry about replacing implants or worry about side effects from implants
  • Ages naturally with the body
  • Naturally adjusts to weight fluctuations (i.e. when you lose weight, your breasts change proportionally)
  • Don’t need future scans
  • If DIEP: tightens abdominal region 

Cons

  • Sometimes difficult to find an experienced/well-trained micro-surgeon
  • Not everyone is a good candidate due to body composition/type, previous abdominal surgeries, or small blood vessels/blood vessels not in the right place
  • Extremely long surgery (mastectomy + reconstruction can be as long as 10-12 hours) 
  • Extremely long and often painful recovery (~a week hospital stay, and then a month of being bedridden)
  • While healing, more physical restrictions for longer (around three months)
  • Use of abdominal binder for weeks/months after surgery
  • If DIEP: Risk of abdominal wall hernia or weakness
  • More than one scar: 1 scar at donor site, other scar on the breasts

Flat

Many surgeons don’t ever actually state that going flat is an option. There are many women who don’t want to deal with the surgeries/potential complications of getting reconstruction, and are perfectly happy with saying “no” to reconstruction altogether and remaining flat post-mastectomy. This is absolutely an option to be considered! 


Make sure that your surgeon is trained in flat closure (ask to see pictures!) so that you avoid dogears and other lumpiness to the chest

Timing of Reconstruction

Direct to Implant (DTI) vs. Delayed Reconstruction

Not everyone is a candidate for DTI reconstruction. If you’re going up significantly in size, or are maintaining size and are already a C+ cup, DTI may not be an option. If you fall into this category, a breast reduction first may make DTI an option. Expanders are a great option for women with C+ cups who don’t want to do a breast reduction first, or women who want to go up in size, but have an increased risk of complications (leakage, infection, deflating expanders, etc.). 


The choice of DTI vs. expanders is very surgeon dependent-- be sure to ask your team what they feel is safe for you! 

Implant Position

Under the Muscle (UTM) vs. Over the Muscle (OTM)

UTM was the standard of breast implant reconstruction for a long time, but OTM is quickly becoming the newer, more advanced, potentially “better” reconstruction option. 


UTM 

  • Pros:
    • Less risk of rippling
    • Potentially better for thinner women with less fat around the breast
    • Easier to find surgeons qualified in UTM than OTM


  • Cons:
    • Cutting the muscle means more complex and difficult recovery with potentially more pain
    • Risk of rippling and visibility of the implant on the edges
    • Risk of hyperanimation
    • Less natural, softer look 
    • Longer recovery to regain range of motion and rebuild the muscle


OTM

  • Pros:
    • Less tightness and chest wall pain because the muscle isn’t cut and stretched
    • Faster recovery
    • No risk of hyperanimation
    • Tends to look more natural with a softer look


  • Cons:
    • Can be difficult for thinner women with smaller breasts or thinner skin 
    • Risk of rippling and visibility of the implant on the edges
    • Potentially higher risk of capsular contracture
    • More difficult to find a surgeon qualified in OTM

"Pre"-Surgeries (Breast Reduction)

If you are relatively “big” in size (e.g. C cup or above), it’s often advised to go smaller (e.g. A or B cup) due to higher risks of nipple necrosis (nipple dying) and infection. Some surgeons offer breast reductions + breast lifts as a separate surgery ~3 months prior to the mastectomy. This is typically a ~4hr outpatient procedure, and helps to prep the pocket for the mastectomy while maximizing chances of retaining the nipple and potentially maintaining sensation.

Sensation

Most women lose sensation in their breasts after mastectomy because the nerves are cut during surgery. But there are options!


Some surgeons offer sensation-preserving techniques. If sensation is important to you, seek out surgeons either trained in microsurgery and nerve grafting/preservation, or surgeons trained in ReSensation. Be sure to confirm with your surgeon that they are trained in the above procedures and ask them about their results.