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 that result from mastectomy or significant breast tissue loss due to cancer treatment. The goal is to restore breast shape, symmetry, and appearance while supporting the patient's emotional recovery and quality of life. The choice between implant-based and autologous tissue reconstruction depends on the type of mastectomy performed, cancer treatments received, the patient's body type, and individual preferences.
Implant-based reconstruction typically involves a two-stage process. In the first stage, a tissue expander is placed beneath the skin or chest muscle at the time of mastectomy or at a later date. The expander is gradually filled with saline over several office visits spanning one to two months to stretch the tissue. In the second stage, the expander is replaced with a permanent silicone or saline breast implant. In select cases, direct-to-implant reconstruction may be performed in a single stage.
Autologous tissue reconstruction, also called flap reconstruction, uses the patient's own tissue harvested from a donor site to create a new breast mound. The deep inferior epigastric perforator (DIEP) flap transfers skin and fat from the lower abdomen without sacrificing abdominal muscle. Other options include the transverse rectus abdominis myocutaneous (TRAM) flap, the latissimus dorsi flap from the back, and free flaps from the thighs or buttocks. Autologous reconstruction generally produces a more natural look and feel that changes with the body over time.
Reconstruction often involves multiple staged procedures. After the primary breast mound is created, additional procedures may include nipple and areola reconstruction using local tissue flaps and tattooing, revision surgery to refine shape and symmetry, fat grafting to smooth contour irregularities, and procedures on the opposite breast to achieve balance. The reconstructive plan is individualized based on each patient's anatomy, health status, and goals.
What to expect
- The patient undergoes a comprehensive evaluation including medical history review, physical examination, and discussion of reconstruction options, timing, and goals with the plastic 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 the patient is 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 in a prepectoral position. When a tissue expander is used, it is gradually filled with saline through an internal valve over multiple office visits to stretch the overlying skin and muscle. After adequate expansion, the expander is exchanged for a permanent silicone or saline implant in a second surgical procedure.
- In DIEP flap reconstruction, skin, fat, and blood vessels from the lower abdomen are carefully dissected while preserving the abdominal muscles. The tissue is transferred to the chest and the small blood vessels of the flap are connected to vessels in the chest wall using microsurgical techniques. The tissue is then shaped into a breast mound.
- The TRAM flap transfers skin, fat, and a portion of the rectus abdominis muscle from the lower abdomen. It can remain attached to its original blood supply and be tunneled to the chest (pedicled TRAM) or be completely detached and reconnected microsurgically (free TRAM).
- The latissimus dorsi flap uses muscle, fat, and skin from the upper back, tunneled beneath the skin to the mastectomy site. Because this flap often does not provide sufficient volume on its own, it is frequently combined with a breast implant to achieve the desired breast size.
- Nipple and areola reconstruction is typically performed as a final stage after the breast mound has healed and settled into its final position. Techniques include local tissue flaps to create nipple projection and three-dimensional tattooing to recreate the areola color and texture.
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 is a surgical procedure that restores breast shape, size, and appearance after mastectomy or significant tissue loss. The two main approaches are implant-based reconstruction, which uses silicone or saline implants, and autologous tissue reconstruction, which uses the patient's own tissue from a donor site such as the abdomen or back. Reconstruction can be performed immediately during mastectomy or delayed until after cancer treatment.
- Patients typically experience discomfort after breast reconstruction, which is managed with prescribed pain medications. Implant-based procedures generally involve less post-operative pain and a shorter recovery than autologous flap surgery, which involves 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 plastic surgeons. As with any surgery, there are potential risks, but serious complications are uncommon. The procedure does not affect breast cancer recurrence risk or the ability to detect recurrence through follow-up exams.
- Breast reconstruction can be performed immediately at the time of mastectomy or delayed until months or even years afterward. Immediate reconstruction has the advantage of beginning the restorative process right away, while delayed reconstruction may be recommended when post-mastectomy radiation therapy is planned or when more time is needed for treatment decisions.
- Implant reconstruction uses a silicone or saline breast implant to create a new breast mound, often with a tissue expander placed first to stretch the skin. Flap reconstruction uses the patient's own tissue from a donor site, most commonly the abdomen (DIEP flap), to build a natural breast mound. Flap procedures generally produce a more natural result that ages with the body, while implant procedures involve shorter initial surgery and recovery.
- Breast reconstruction may not be appropriate for patients with active untreated cancer requiring further treatment, uncontrolled medical conditions that increase surgical risk, or active infections. Tobacco use significantly increases the risk of complications, especially with flap procedures, and cessation is strongly recommended. A plastic surgeon evaluates each patient individually to determine the safest approach.
- Recovery depends on the type of reconstruction. Implant-based procedures typically allow a return to light activities within two to three weeks. Autologous flap reconstruction involves a longer recovery, with most patients resuming normal activities within six to eight weeks. Full healing and final breast shape continue to develop over several months, and additional staged procedures may be scheduled after the primary reconstruction has healed.
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: 2026-06-13