Breast Reconstruction in Delafield
Rebuilding form, and a sense of whole.
Breast reconstruction is a surgical procedure that restores one or both breasts to near normal shape, appearance, symmetry, and size following mastectomy, lumpectomy, or congenital deformity. Options include implant-based reconstruction using tissue expanders and permanent implants, autologous tissue reconstruction using the patient's own tissue from donor sites such as the abdomen or back, and combination approaches. Reconstruction can be performed immediately at the time of mastectomy or delayed until after cancer treatment is complete.
At a Glance
- Immediate breast reconstruction rates in the United States increased from approximately 8% of mastectomy patients in 1995 to about 41% in 2013[6]
- Implant-based reconstruction surpassed autologous techniques as the most common method in 2002, with implant procedures increasing approximately 11% yearly between 1998 and 2008[6]
- Autologous reconstruction with DIEP flap has demonstrated greater patient satisfaction with both aesthetic outcomes and the overall reconstructive process compared to implant-based reconstruction[7]
- Breast reconstruction does not change the risk of breast cancer recurrence[3]
Overview
Breast reconstruction addresses the physical changes left by mastectomy or significant breast tissue loss from cancer treatment. Its goals are to restore breast shape, symmetry, and appearance while supporting emotional recovery and quality of life. The choice between implant-based reconstruction and reconstruction with the patient’s own tissue depends on the type of mastectomy, cancer treatments received, body type, and individual preferences.
Implant-based reconstruction usually takes place in two stages. A tissue expander is placed beneath the skin, either below the chest muscle or in a prepectoral position, during mastectomy or at a later date. It is gradually filled with saline during office visits over one to two months. A second procedure replaces the expander with a permanent silicone or saline implant. In select cases, reconstruction may proceed directly to an implant in a single stage.
Autologous reconstruction, also called flap reconstruction, uses tissue from another area of the patient’s body to form a breast mound. A DIEP flap transfers skin and fat from the lower abdomen without sacrificing abdominal muscle. Other options include a TRAM flap, a latissimus dorsi flap from the back, and free flaps from the thighs or buttocks. Autologous reconstruction generally has a more natural look and feel and changes with the body over time.
Reconstruction often involves more than one operation. Once the breast mound has healed, later procedures may reconstruct the nipple and areola with local tissue flaps and tattooing, refine shape or symmetry, use fat grafting to smooth contour irregularities, or adjust the opposite breast for balance. The plan is individualized to the patient’s anatomy, health status, and goals.
What to expect
- A comprehensive evaluation includes a review of your medical history, a physical examination, and a discussion of reconstruction options, timing, and goals with the operating surgeon.
- For implant-based reconstruction, a tissue expander is placed in a pocket beneath the chest muscle or above it during mastectomy or at a later date under general anesthesia.
- The tissue expander is gradually filled with saline during periodic office visits over one to two months until the desired breast volume is achieved.
- In a second procedure, the tissue expander is exchanged for a permanent breast implant, and the surgeon refines the shape of the breast pocket.
- For autologous flap reconstruction, the surgeon harvests tissue from the donor site (abdomen, back, thigh, or buttocks) and transfers it to the chest under general anesthesia.
- In free flap procedures, the surgeon connects the flap's blood vessels to recipient vessels in the chest using an operating microscope (microvascular anastomosis).
- The transferred tissue is shaped into a breast mound, and the donor site is closed.
- Surgical drains are placed to remove excess fluid, and you are monitored in the hospital for one to several days depending on the procedure type.
- After healing, nipple and areola reconstruction may be performed using local tissue flaps and tattooing techniques.
- Revision procedures may be performed to refine symmetry, shape, or contour as needed.
How a breast reconstruction works
- In implant-based reconstruction, a tissue expander or breast implant is placed beneath the pectoralis muscle or above it in a prepectoral position. An expander has an internal valve and is filled gradually with saline over several office visits, stretching the overlying skin and muscle. Once expansion is complete, a second operation replaces it with a permanent silicone or saline implant.
- A DIEP flap uses skin, fat, and blood vessels from the lower abdomen while preserving the abdominal muscles. The tissue is transferred to the chest, where the flap’s small blood vessels are connected to vessels in the chest wall using microsurgical techniques. The transferred tissue is then shaped into a breast mound.
- A TRAM flap transfers lower abdominal skin, fat, and part of the rectus abdominis muscle. A pedicled TRAM remains attached to its original blood supply and is tunneled to the chest. A free TRAM is completely detached and its blood vessels are reconnected microsurgically.
- A latissimus dorsi flap uses muscle, fat, and skin from the upper back. The tissue remains attached and is tunneled beneath the skin to the mastectomy site. Because this flap often does not provide enough volume by itself, it is frequently combined with a breast implant.
- Nipple and areola reconstruction is typically reserved for a final stage, after the breast mound has healed and settled into its final position. Local tissue flaps can create nipple projection, while three-dimensional tattooing recreates the color and texture of the areola.
- Dr. Boehm performs breast reconstruction at Consona, along with the procedures that may refine it over time: fat grafting for contour irregularities, revision surgery, implant exchange, and surgery on the opposite breast for symmetry. How an immediate reconstruction during mastectomy would be coordinated with a hospital, surgical oncologist, and oncology team is determined at consultation. A published service list does not settle that coordination.
When it's recommended
- Restoration of breast shape and appearance following mastectomy for breast cancer
- Reconstruction after lumpectomy when significant tissue has been removed
- Breast restoration following prophylactic mastectomy in patients with high cancer risk
- Correction of significant breast asymmetry resulting from surgery or congenital conditions
- Reconstruction following traumatic breast tissue loss
- Staged completion of previously started reconstruction
Is a breast reconstruction right for you?
Reach out to learn more from Dr. Lucas Boehm.
Concerns it addresses
Recovery & aftercare
- Hospital stay ranges from one day for implant-based procedures to three to five days for autologous flap reconstruction
- Surgical drains are typically in place for one to three weeks after surgery
- Initial wound healing generally occurs over two to four weeks
- Patients can usually return to light daily activities within two to four weeks depending on the procedure type
- Strenuous physical activity and heavy lifting are restricted for four to six weeks after surgery
- Tissue expander fills occur during periodic office visits over one to two months
- Swelling and bruising gradually resolve over several weeks, with breast shape and position continuing to improve
- Full recovery from autologous flap reconstruction may take six to eight weeks
- Final breast shape continues to settle and refine over several months
- Additional staged procedures (nipple reconstruction, revisions) are scheduled after the primary reconstruction has healed
Alternatives
- External breast prosthesis (worn inside a bra or attached to the skin)
- Oncoplastic surgery (reshaping remaining breast tissue during lumpectomy)
- Autologous fat grafting alone for modest volume restoration
- No reconstruction (flat closure)
Related treatments
Frequently Asked Questions
- Breast reconstruction restores breast shape, size, and appearance after mastectomy or significant tissue loss. Implant-based reconstruction uses a silicone or saline implant, often after a tissue expander has stretched the skin. Autologous reconstruction uses the patient’s own tissue, commonly from the abdomen or back. Either approach may be performed during mastectomy or delayed until cancer treatment is complete.
- Discomfort after breast reconstruction is typical and is managed with prescribed pain medication. Implant-based procedures generally involve less post-operative pain and a shorter recovery than flap reconstruction, which creates a second surgical site. Most patients report that pain is manageable and decreases significantly within the first one to two weeks.
- Breast reconstruction is a well-established procedure performed by board-certified surgeons. As with any surgery, it carries potential risks, but serious complications are uncommon. Reconstruction does not change the risk of breast cancer recurrence or interfere with the ability to detect recurrence through follow-up examinations.
- Reconstruction may be immediate, taking place during mastectomy, or delayed for months or even years. Immediate reconstruction begins the restorative process at the time of mastectomy. Delayed reconstruction may be recommended when post-mastectomy radiation therapy is planned or when more time is needed to make treatment decisions.
- Implant reconstruction creates the breast mound with a silicone or saline implant and often begins with a tissue expander. Flap reconstruction builds the mound with the patient’s own tissue, most commonly through a DIEP flap from the abdomen. Flap reconstruction generally produces a more natural result that ages with the body. Implant reconstruction involves a shorter initial operation and recovery.
- Breast reconstruction may not be appropriate for someone with active untreated cancer requiring further treatment, an active infection, or an uncontrolled medical condition that substantially increases surgical risk. Inadequate donor tissue may rule out an autologous approach. Tobacco use significantly increases complication risk, particularly with flap procedures, and cessation is strongly recommended. Planned post-mastectomy radiation may require delaying certain approaches. The operating surgeon evaluates each patient individually to determine the safest option, including whether expectations can be resolved through counseling.
- Recovery depends on the procedure. Implant-based reconstruction typically permits a return to light activities within two to three weeks. After autologous flap reconstruction, most patients resume normal activities within six to eight weeks. Healing and breast shape continue to develop over several months, and nipple reconstruction or other revisions may be scheduled after the primary reconstruction has healed.
- Dr. Boehm performs breast reconstruction, fat grafting for contour, revision surgery, implant exchange, and symmetry surgery on the opposite breast. What is not established by the published information is how immediate reconstruction alongside a mastectomy would be coordinated with a surgical oncologist and hospital. That coordination is addressed directly at consultation.
- Often. Under the Women’s Health and Cancer Rights Act of 1998, a group health plan that pays for a mastectomy is also obliged to pay for reconstruction and related procedures. At Consona, aesthetic surgery is private-pay, and insurance claims are not submitted to any plan. The first conversation is therefore with the health plan and treating team. Having it early costs nothing, and the answer may change where the procedures take place and who performs them.
Breast Reconstruction risks & candidacy
Who should avoid this
- Active untreated breast cancer requiring further oncologic treatment before reconstruction
- Active infection at the planned surgical site
- Significant medical comorbidities that substantially increase surgical risk, such as uncontrolled diabetes or severe cardiac disease
- Active tobacco use, which compromises blood flow to flaps and increases complication risk (cessation is strongly recommended before surgery)
- Inadequate tissue at donor sites for autologous reconstruction
- Unrealistic expectations about surgical outcomes that cannot be resolved through counseling
- Planned post-mastectomy radiation therapy may require delaying certain reconstruction approaches
Possible risks
- Infection at the surgical or donor site
- Bleeding or hematoma formation requiring drainage
- Seroma (fluid accumulation beneath the wound)
- Poor wound healing or wound dehiscence
- Partial or complete loss of the tissue flap (flap necrosis)
- Capsular contracture (hardening of scar tissue around an implant)
- Implant rupture, malposition, or asymmetry
- Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a very rare form of immune system cancer
- Breast implant-associated squamous cell carcinoma (BIA-SCC), an extremely rare cancer in the implant capsule
- Breast implant illness (BII), which may include fatigue, cognitive changes, muscle or joint pain, and rash
- Loss of sensation at the reconstructed breast or donor site
- Donor site pain, weakness, or contour deformity (for autologous reconstruction)
- Blood clots (deep vein thrombosis or pulmonary embolism)
- Scarring at the breast and donor sites
- Need for additional revision surgeries
Your surgeon
Care that respects what makes you, you.
Dr. Lucas Boehm is a Wisconsin native, board-certified, fellowship-trained plastic surgeon and the founder of Consona Plastic Surgery and Aesthetics. His practice is dedicated exclusively to aesthetic surgery of the face, nose, breast, and body, with particular expertise in deep plane facelifts, rhinoplasty, and aesthetic breast surgery. He completed his undergraduate education at the University of Wisconsin–Madison, earned his medical degree from the Medical College of Wisconsin, and completed his plastic surgery residency there as well. He then pursued an Aesthetic Society-endorsed fellowship in aesthetic surgery under the mentorship of Dr. Bradley Calobrace in Louisville, Kentucky. Known for meticulous attention to detail, he approaches each case with precision and intention. His philosophy emphasizes harmony and balance – enhancing what is already beautiful while ensuring every change feels natural, thoughtful, and uniquely you.
- Board-certified
- Am. Board of Plastic Surgery
- Fellowship-trained
- Aesthetic surgery
- 12+ years
- In practice
Sources & references
This article draws on 7 sources, including peer-reviewed research.
Government & research
Educational & general
- National Cancer Institute - Breast Reconstruction After Mastectomy
- American Society of Plastic Surgeons - Breast Reconstruction
- American Society of Plastic Surgeons - Breast Reconstruction Risks and Safety
- American Society of Plastic Surgeons - Breast Reconstruction Techniques
- American Cancer Society - Breast Reconstruction Options
Medically reviewed by Dr. Lucas Boehm, MD · Last reviewed: 2026-09-12