Dr John Di Saia, an orange county california plastic surgeon

Breast Reconstruction - After Breast Cancer


Breast Cancer is unfortunately quite common in Southern California. The incidence is about 1 in 8 American women over the course of a lifetime. Breast Reconstruction offers women treated by Mastectomy the opportunity to approach normalcy once again. Some interesting facts:
  • Breast reconstruction until the mid-1980's was almost always performed in a delayed fashion - meaning years following Mastectomy. This lead to less attractive results.
  • The surgery can be performed in a number of different ways, but almost always requires multiple operations (Stages).
  • Breast reconstruction is quite a bit more difficult than cosmetic breast surgery in the majority of cases.
  • Breast reconstruction is almost always covered by health insurance.
Then again breast reconstruction offers hope to many women who have lost a breast to cancer. The alternative to breast reconstruction after mastectomy sits to the right.
An Alternative to Breast Reconstruction - A Woman following Mastectomy
Patient following Mastectomy without Reconstruction

As might be unexpected, breast reconstruction is controversial....in the media and even amongst physicians. Early in its history, physicians were concerned that surgery to restore the breast was potentially problematic to the continued screening of the patient for recurrent cancer. Advanced breast cancer should be treated aggressively. In these women it might be best to delay or even withhold breast reconstruction. For the majority of women presenting with early disease. immediate reconstruction is low risk.

The Basics of Breast Reconstruction

The basic variations are:

(1) Immediate versus Delayed Reconstruction

(2) Implant-based versus Tissue-based Reconstruction

Immediate Reconstruction starts at the time of mastectomy. In this case breast mound reconstruction directly follows the cancer operation. Obviously, Delayed Reconstruction occurs some time following mastectomy either because of patient preference, patient health or extensive cancer at mastectomy.

Implant-based Reconstruction involves the use of breast implants and tissue expanders. Breast mound reconstruction is facilitated by stretching the skin with a balloon (Expander). A later operation is performed to remove the expander and place a permanent implant. Tissue-based Reconstruction involves the use of the patient's own tissues most often moved from the abdomen or back to provide volume for a breast mound. In some cases, one or the other type will be recommended. The tissue-based versions provide a better aesthetic result but require a larger operation and more disability to get there. At this point in the United States, about 70% of breast reconstructions are performed using Expanders and implants. A example of an implant reconstruction follows:

An Immediate Breast Implant Reconstruction

Prior to Mastectomy and Immediate Implant Reconstruction-stage I 8 months after Mastectomy and Immediate Implant Reconstruction-stage I 2 months after Nipple-Areolar Reconstruction- Stage II

This young woman had an early invasive breast cancer. She chose mastectomy and wished an immediate reconstruction with as little as possible opposite breast surgery. She was neither a smoker nor a diabetic and it was not predicted that she would need post-operative radiation therapy. A skin-sparing mastectomy was performed by her general surgeon after which Dr D placed a small breast implant. This is sometimes possible in patients with healthy skin following mastectomy A year later, she chose to have nipple-areolar reconstruction, an outpatient operation.

Tissue Expansion Technique

Tissue Expansion can offer favorable results, but is more susceptible to the variable healing after mastectomy, chemotherapy and radiation therapy than tissue-based techniques. It is easier on the patient from the disability standpoint. An example is laid out HERE.

Breast Reconstruction Surgery and Risk

Reconstruction of the breast following Mastectomy is very different than cosmetic breast surgery. The outcome is rarely as pleasing, but the alternative as seen above is not so pleasing either. The risk of problems in reconstruction dwarfs that in cosmetic surgery as well:
  • Skin Necrosis - After mastectomy the skin of the breast is compromised as the underlying breast has been completely removed. If this skin is unable to heal, additional surgery is frequently required. Furthermore, in these cases implants can be lost and scar can result in a good deal of distortion and therefore a poor aestheic outcome.
  • Capsular Contracture - The size of the wound at mastecomy and reaction of the patient's tissues to breast implants (if used) put reconstructive patients at higher risk of significant breast hardening or capsular contracture. Patients can develop distortion and pain which may lead to the need for further surgery.
  • Scarring, Hernia and Distortion - Tissue-based reconstructions leave a second wound with the possibility of hernia formation, poor scarring and other complications related to the size of the wound.
  • Immediate Reconstruction leads to better aesthetic results when implant-based techniques are employed.


Dr Di Saia for Breast Reconstruction

Dr Di Saia is a board-certified plastic surgeon who was first certified in general surgery. In years gone by, he used to perform the breast removal surgery. He much more enjoys the process of creating a new breast for you. He also enjoys the challenge of improving breast reconstruction cases in which other surgeons have said it cannot be done. See some of these cases from our main breast section here.

More Information on Breast Implants in Reconstruction

* FDA Consumer Statement On Breast Implants
* Inamed (now Allergan) Medical's Patient Informed Consent Brochure - FDA  PDF format
*Mentor's Patient Informed Consent Brochure - FDA  PDF format


© John Di Saia, MD... an Orange County California Plastic Surgeon       

Serving Southern California since 1997 * (949) 369-5932


Please note that this resource is offered freely to individuals considering plastic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.