For women who have had a mastectomy or lumpectomy, breast reconstruction surgery helps restore the appearance of the breasts. Research has shown that the procedure can improve quality of life and boost a woman’s self-esteem. 

“Breast reconstruction helps restore patients’ satisfaction with their bodies by making them more comfortable in their clothing and allowing them to regain confidence in relation to intimacy and sexuality,” says Michael Alperovich, MD, a Yale Medicine plastic and reconstructive surgeon.

In addition to restoring breasts after a lumpectomy or mastectomy, breast reconstruction procedures are also used to address congenital deformities such as Poland syndrome or tuberous breast deformity, or to address inverted nipples and enlarged areolas (the pigmented area around the nipple).

There are several types of breast reconstruction approaches. Breast implants can be used or the surgeon may reconstruct the breast using blood vessels, fat, and skin from the abdomen—a procedure called autologous or DIEP flap reconstruction.

With implants, doctors sometimes use a woman’s own body fat to surgically reshape one or both breasts for a more natural look and feel in a procedure called fat-grafting. If your natural breasts show signs of sagging, your doctor may also recommend a breast lift. Your doctor can also address concerns about the way your breasts look—for example, making adjustments to the shape or asymmetrical size of the areolas.

The most common form of breast reconstruction is a two-stage implant reconstruction. In the first stage, a tissue expander is placed in your breast. This is a temporary device used to expand the skin and muscles to create space for an implant. The device is inflatable; the doctor gradually inflates it over many weeks to stretch the skin and muscles. In the second stage, the tissue expander is removed and the patient either receives permanent implants or undergoes the flap reconstruction procedure.

Usually breast reconstruction is done immediately following a mastectomy while you’re still under anesthesia. If the patient prefers, reconstruction is performed at a later date. Your surgeon will review your options and help you make the decision that is right for you.

Federal law requires that breast reconstruction be covered by insurance policies for all patients at any time after the cancer is removed.

Poland syndrome is a congenital disorder in which people are born with missing or underdeveloped chest muscles on one side of the body, making that side appear concave. It is sometimes identified at birth, but often doesn’t become apparent until puberty. 

Breast reconstruction for Poland syndrome typically involves a custom-made implant that helps to reshape the chest on the affected side of the body to create a more symmetric appearance. If the nipple is affected, a procedure to alter its appearance may be incorporated into the surgery as well. Sometimes Poland syndrome also affects the hand and fingers; if so, a patient may benefit from plastic and reconstructive hand surgery.

Tuberous breast deformity is a congenital condition that shows up when breast development begins during puberty. Tuberous breasts are cylindrical rather than rounded and do not grow symmetrically. Sometimes, one breast does not develop at all—or one or both breasts may have an areola that is too wide. Treatment is customized to each patient’s needs. (Some health plans don’t consider this procedure medically necessary for people with tuberous breast deformity, so insurance coverage varies.)

Like any procedure, there are risks, including:

• Infection
• Loss of breast sensation
• Scarring
• Misalignment, requiring revision surgery
• Leakage or rupture
• Capsular contracture (scar tissue around the implant)
• Wrinkling
• Stretch marks
• Pain and discomfort

During surgery, your doctor will make an incision to create a “pocket” in which to insert the implant, typically at the bottom of the breast or around the areola. Other potential incision sites include the underarm and naval, but this isn’t always a possibility. Your surgeon will recommend the ideal placement for your incision.

Breast implants can be placed either above or underneath the pectoral muscles. There are advantages to each. Locating them underneath the muscle may cause more post-surgery discomfort and require a longer recovery time, but implants placed there often feel more natural to the touch than implants placed above the pectoral muscles.

There are several types of breast implants. These include:

• Saline breast implants: Silicone shells filled with sterile salt water.
• Silicone breast implants: Silicone shells filled with a soft gel.
• Cohesive gel silicone implants: Silicone shells filled with a thicker gel.

Breast implants also come with a smooth or textured surface. The benefit of textured-surface implants is there’s a lower incidence of capsular contracture. Smooth-surfaced implants, however, are more rarely associated with ALCL, which is a very uncommon form of cancer.

At Yale Medicine, our plastic and reconstructive surgeons are known for their expertise in treating the most complicated breast reconstruction cases.

“Breast reconstruction can take so many different forms. You want to be at a regional center that offers all of the cutting-edge options, so that then you can choose the best one given your diagnosis, overall health and desires,” says Dr. Alperovich. “We strive to offer you the support you need in order to make a safe surgical plan that will restore your body and help you heal."