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MUSC Health’s surgeons perform migraine surgery on Denise Stout at Ashley River Tower.

What You Should Know About Breast Reconstruction

Today, women who lose one or both breasts to cancer and mastectomy can benefit from state-of-the-art opportunities in reconstruction. At MUSC, we believe each woman should have access to the full range of options including those for implant reconstruction as well as revolutionary techniques for natural tissue reconstruction, which our doctors have helped to advance.

Which Breast Reconstruction Procedure is Right for You?

We can help you determine what will work best for you and also help with choices on other issues, for example, whether to delay reconstruction or have it done at the time of mastectomy. We want you to explore and understand all the possibilities so that you will be fully satisfied with the results of your reconstruction.

MUSC offers numerous breast reconstruction procedure options. Your doctor can work with you to better determine which procedure is right for you based on your needs. Learn more about our procedure options below.

Delayed vs. Immediate

The timing of breast reconstruction will depend on your circumstances and personal wishes. Some patients are able to have immediate reconstruction at the same time as mastectomy. Others delay reconstruction until after recovery from mastectomy and subsequent cancer treatments.

Delayed

For the best cosmetic results, mastectomy patients who will undergo radiation and or chemotherapy are advised to delay reconstruction until their treatments have been completed.

If you plan on delayed reconstruction, it’s best to have a tissue expander put in place at the time of mastectomy to make room for a permanent implant or natural tissue (autologous) reconstruction. The tissue expander acts as a space-saver and prevents the skin from scarring down to the chest wall after radiation, which would otherwise complicate reconstruction. The expander will be filled with saline during the procedure, but the degree of expansion will be limited at the time of surgery by the amount of available skin left following mastectomy. Once the incisions from surgery heal, more saline can be inserted during a series of follow-up office visits, allowing your breasts to expand over time to the size you desire.

Ultimately, the tissue expanders will be exchanged for implants or natural tissue during reconstruction. Each patient’s situation is unique, and the timing of your delayed reconstruction will depend on your cancer treatment.

Immediate

Some patients are candidates for one-step breast reconstruction in which they skip using tissue expanders and have natural tissue reconstruction or implants placed at the time of mastectomy. This option is typically reserved for women who will not need radiation treatment. For those who are eligible, it promises more simplicity and less disruption to daily life.

Natural Tissue vs. Implant

One of your biggest decisions will be whether to have reconstruction with breast implants – which can be placed easily but have a limited lifetime – or to have reconstruction using your own tissue, which is more involved initially but can offer a permanent solution as well as several other benefits. There are advantages and disadvantages to consider for each.

Implant reconstruction

Implant reconstruction only takes about one hour when done on both sides (bilateral). It requires a short hospitalization of one to two days when performed at the time of mastectomy and can be done on an outpatient basis if reconstruction is delayed.

However, if you opt for an implant you will be adding a foreign object to your body, and that will increase your risk of infection soon after surgery. In addition, the implant might move, so it’s no longer positioned correctly, or fail in other ways.

One of the most common problems is capsular contracture in which the scar tissue (capsule) that forms around the implant starts to tighten, making the breast feel hard and painful and look distorted.

Also note that when implants are used for reconstruction a woman has little to no breast tissue left to cover them. As a result, breasts reconstructed with implants will not feel or look as natural as breasts that have been enlarged with implants for cosmetic reasons. Yet women who have implants can expect to gain more breast sensation than those who have natural tissue reconstruction.

An implant will rupture and will require more surgery at some point. The average lifespan of an implant is 13.5 years. Replacement of an implant usually only takes about 30 minutes and can be done through an outpatient procedure.

Natural tissue reconstruction

With this approach, the surgeon transplants tissue from one part of your body and uses it create a soft, full breast that should live with you for the rest of your life. At MUSC, we often transfer a flap of skin and fat from the abdomen, typically using the DIEP procedure, which has a success rate around 97-98 percent. But a flap of tissue may be taken from the buttocks, thigh or back, depending on what will work best for you.

Because the flap is made of your own tissue, it will continue to act as a part of you, for example, growing or decreasing in size as you gain or lose weight. Your breasts will look and hang in a more genuine way and will feel more natural to the touch than breasts reconstructed with implants.

It’s important to know that natural tissue reconstruction may involve more time and effort on the front end than implant reconstruction. Yet the plastic surgeons at MUSC are able to perform the initial procedure in half the time of some centers with less experience. It usually takes us three to four hours to reconstruct one breast with natural tissue and microsurgery – six to eight hours to reconstruct two breasts. Afterward, you will stay in the hospital three to four days.

Patients often have a revisional surgery to make the breasts look as similar as possible and to resolve any issues from your abdominal scar. This second surgery is typically a one-hour outpatient procedure. Nipple reconstruction may be done at this time or in a later outpatient procedure.

Unilateral and Bilateral Mastectomy

A unilateral mastectomy involves the removal of one breast, while a bilateral mastectomy involves both breasts. If you have cancer in one breast, you may decide to have the other breast removed at the same time as a cancer prevention measure (prophylactic mastectomy).

If you are having a bilateral mastectomy, you also can undergo reconstruction of both breasts at the same time with the same reconstructive technique, whether you use implants or your own natural tissue. Or you may preserve your natural, cancer-free breast and undergo a symmetry procedure – for example, a breast reduction or breast lift – to ensure that your natural breast looks similar to your newly reconstructed breast.

Acellular Dermis

Acellular dermis is human tissue that is taken from the back of a cadaver and processed in a way that prevents rejection and infection. In recent years, surgeons have started to use acellular dermis as a helpful tool in breast reconstruction.

Following a mastectomy, there is minimal breast tissue left. Acellular dermis incorporates into your own tissue and allows better structural support. Women who delay reconstruction typically have a tissue expander inserted at the time of mastectomy as a space-saver. Acellular dermis is used to create a sling that helps hold the tissue expander in place while also providing an extra layer of tissue between the expander and skin.

When used with implant reconstruction, acellular dermis makes the implant less visible and less likely to be felt under the skin. It can help control the implant’s location, define the breast crease and provide additional tissue for a more natural looking breast.

Need more information? Learn more about what breast reconstruction patients at MUSC can expect, or explore further details on our procedures.

Additional Information for Breast Reconstruction Patients

Managing Lymphedema

Preparing for Surgery

High Risk Breast Program

Our Breast Reconstruction Procedures

Natural Tissue Reconstruction

Use of natural tissue in breast reconstruction has evolved over time, and there are several different procedures with shorthand names usually related to the muscles or blood vessels involved.

Implant Reconstruction

Patients may choose an implant over natural tissue reconstruction if they don’t want to use their own tissue in breast reconstruction, don’t want a longer hospital stay up front or don’t want additional scarring on other areas of their body.

Tissue Expanders

The tissue expander is an empty silicone envelope with an access port. At the time of mastectomy, your plastic surgeon will place the tissue expander in a space created by your breast surgeon, under the pectoralis muscle. A graft of donated human tissue (acellular dermis) creates a sling to help hold the tissue expander in place and provides an extra layer of “tissue” between the tissue expander and skin.

Breast Symmetry

If you are having a mastectomy on one side and intend to preserve your cancer-free breast, symmetry procedures may be done on the preserved breast during a secondary stage in the reconstruction process.

Revision of Previously Reconstructed Breasts

An experienced and proven plastic surgeon can turn a mediocre reconstruction into an excellent restoration. If a woman comes to us dissatisfied with an earlier procedure, we usually are able to help.

Cosmetic Breast Surgery

Cosmetic breast surgery procedures include breast augmentation, breast reduction, and mastopexy.

Nipple/Areola Reconstruction

Our procedures include nipple reconstruction and 3D areola tattoos.