Andrew M. Bonett, MD

Hi, it’s Dr. Bonett at Naples Plastic Surgery. So how does breast reconstruction work after a mastectomy? Unfortunately, breast cancer is very common. Fortunately, it is often caught early, and so sometimes you might be able to get away — if you’re unfortunate enough to have a breast cancer diagnosis — with a lumpectomy, which is a small, sometimes a golfball size for example, piece of tissue that can cause a deformity of the breast, we can do reconstruction. 

Most commonly, there’s going to be a complete mastectomy, which is removing all the breast tissue, and often times the nipple and areola complex as well. Then you’re talking about full breast reconstruction. So the way to think about a mastectomy is the breast surgeon is removing all the breast tissue under the skin, and they’re leaving behind all the skin of the breast which is continuous with your chest and your abdomen. Breast reconstruction is really restoring that volume again. 

There’s two main categories of breast reconstruction. You can call is alloplastic breast reconstruction of autologous. Alloplastic means using implants. Autologous means using your own tissue. Using implants is more common still, but autologous, or using your own tissue, is becoming more and more common. The best procedure for autologous reconstruction is using your abdominal tissue. It is a pretty major surgery, and it’s considered a micro surgery and usually performed at academic centers or big institutions. Because of all the resources that requires, it is still most common to use implants for reconstruction.

If we’re deciding to go the alloplastic or implant based route, sometimes you can actually have implants placed on the day of the mastectomy. That’s called direct to implant reconstruction. But what’s more traditionally done is a two step approach where at the same time as the mastectomy is performed, a tissue expander is put in, which is kind of a space saver, and something you can add volume to over time, so there’s not too much stress on the skin at the time of the mastectomy. Then there is a second much smaller surgery later where that tissue expander is removed and the final implant goes in. At that time we can often do other procedures like fat transfer from the abdomen or the thighs to the skin of the breast to help with smaller irregularities.

Breast reconstruction is a huge topic to cover in one minute, but when you come in for a consultation we really take our time to talk to you about the entire process and all the steps involved.