Breast Reconstruction

Breast reconstruction is surgery that rebuilds breast shape after mastectomy, lumpectomy, injury, or other tissue loss. It may be performed at the time of mastectomy or delayed until after healing or additional treatment.

• Breast implants
• Tissue expanders followed by implants
• The patient’s own tissue
• Fat grafting
• Nipple and areola reconstruction
• Procedures on the opposite breast to improve symmetry
• A combination of staged reconstructive techniques

The goal is not necessarily to reproduce the breast exactly as it existed before treatment. The goal is to create a breast shape and chest contour that feel balanced, comfortable, and appropriate for the patient’s body and medical journey.

Dr. Lovelace can review your treatment plan, tissue quality, prior procedures, and goals during a personalized consultation.

Breast reconstruction is not one procedure. Dr. Lovelace evaluates the patient’s anatomy, remaining skin and tissue, treatment history, radiation exposure, donor tissue, health, and preferences before recommending an approach.

Implant-Based Breast Reconstruction

Implant-based reconstruction uses a saline or silicone implant to restore breast volume and shape. It may be appropriate for patients with adequate skin and soft-tissue coverage who prefer to avoid a larger donor-site operation.

• Direct-to-implant reconstruction: In select cases, a permanent implant may be placed at the time of mastectomy.
• Tissue expander to implant reconstruction: A temporary expander is gradually filled to prepare the tissue before exchange for a permanent implant.
• Latissimus dorsi flap with implant: Tissue from the back may be used to add coverage and support, often in combination with an implant.

Although implant-based reconstruction and cosmetic breast augmentation both use implants, reconstructive surgery is planned around tissue removal, chest anatomy, treatment history, skin quality, and restoring shape after mastectomy or trauma.

Autologous or Flap-Based Reconstruction

Autologous reconstruction uses the patient’s own tissue to rebuild the breast. It may provide a natural tissue feel and may be considered when implant coverage is limited or prior radiation has affected the chest tissue.

• TRAM flap: Uses lower-abdominal skin, fat, and muscle.
• DIEP flap: Uses lower-abdominal skin and fat while preserving the abdominal muscles through microsurgical techniques.
• SGAP or IGAP flap: Uses tissue from the upper or lower buttock region when abdominal tissue is not available or preferred.

Not every reconstructive technique is performed in every setting. If a procedure requires specialized microsurgery or multidisciplinary care, Dr. Lovelace can explain the appropriate next steps and coordination.

Fat Grafting

Fat grafting uses fat removed from another area of the body and transfers it to the breast or chest. It may be used to soften contour irregularities, improve implant coverage, refine a flap reconstruction, or address selected lumpectomy-related defects.

Nipple and Areola Reconstruction

After the breast mound has healed, nipple and areola reconstruction may be considered. Options may include surgical reconstruction, medical tattooing, or a combination. This is often performed as a later stage after the breast shape has stabilized.

Many patients consider reconstruction after mastectomy performed for breast cancer treatment or risk reduction. Reconstruction after mastectomy focuses on rebuilding the breast mound and restoring a more natural chest contour after breast tissue has been removed.

The surgical plan depends on the type of mastectomy, the amount and condition of the remaining skin, chest-wall tissue, prior scars, radiation history, overall health, and desired outcome.

Potential approaches include implant-based reconstruction, staged tissue expansion, flap-based reconstruction using the patient’s own tissue, or a combination of methods. Some patients are candidates for reconstruction at the same operation as mastectomy, while others benefit from waiting.