Breast Reconstruction Options After Breast Cancer

A breast cancer diagnosis—or learning you carry a gene that increases your risk—is incredibly hard. We are truly sorry you are going through this. Your first priority is your cancer care, your health, and your overall well-being. Dr. Carpenter and our entire team at Vitruvian Surgical Institute are here to walk beside you through this process. Our goal is to make your reconstruction as straightforward and supportive as possible so you can focus on healing and get back to your life.

Every woman is unique, and Dr. Carpenter takes the time to develop personalized surgical plans  tailored to your body and your goals. When it comes to breast cancer reconstruction, the options can seem endless and overwhelming. This page is meant to help prepare you for your breast cancer reconstruction discussion and to provide an overview of your key options. Dr. Carpenter will explain your best options with you in further detail. 

In 1998, the Women’s Health and Cancer Rights Act (WHCRA) became federal law to protect patients who choose breast reconstruction after a mastectomy. If your health plan covers mastectomy, it must also cover:

• All stages of reconstruction of the breast on which the mastectomy was performed 
• Surgery and reconstruction of the other breast to produce a symmetrical appearance 
• Prostheses 
• Treatment of physical complications of the mastectomy, including lymphedema

While WHCRA provides strong protections, some insurance plans may consider reconstruction after lumpectomy or other breast-preserving procedures as not medically necessary. In addition, payers sometimes limit the number of revision surgeries they will cover. We are happy to work with you and your insurance team to understand exactly what your plan covers and to advocate for the care you need and deserve.

Before we meet, it helps to reflect on a few key questions. These details guide every decision we make together:

• Lumpectomy: Only the portion of the breast with the tumor is removed, which can make the breast smaller. This is often followed by radiation therapy. 
• Simple mastectomy: Removal of all breast tissue, including the nipple. This reduces the size of the 'breast envelope'.
• Nipple-sparing mastectomy: Removal of breast tissue while preserving most or all of the breast skin and the nipple-areola complex. Not all women are candidates for a nipple-sparing approach, ask your breast surgeon if your tumor is small enough and far away enough from the nipple to allow your nipples to be preserved.
• Unilateral or bilateral? You may be having surgery on only the cancer-affected breast, or on both sides for symmetry, risk reduction, or peace of mind. From a final aesthetic result standpoint, Dr. Carpenter can perform procedures on your contralateral breast if you elect for a unilateral mastectomy to maximize your symmetry as much as possible.

Radiation is an important piece of the puzzle because it can affect the final aesthetic result and the timing of reconstruction. We keep this in mind when choosing the best technique and schedule for you.

There are hundreds of ways to approach breast reconstruction, and the right path for you depends on your planned cancer operation, whether radiation will be part of your treatment, your prior surgical history, your overall health, and—most importantly—your personal preferences and goals.

Some women choose not to have reconstructive surgery at all. This is a completely personal and 

valid decision. You may wear (or not wear) an external breast prosthesis. 

If you decide to not undergo breast reconstruction, Dr. Carpenter can perform a reduction on the non-affected breast for better symmetry and to reduce any weight imbalance that could cause back or shoulder strain. Dr. Carpenter can also perform an aesthetic flat closure, where no reconstruction is performed, but she helps close your mastectomy scar to avoid contour irregularities.

Women choose this option for many reasons: if additional surgeries are not ideal for their health, if they want to finish cancer treatment as quickly as possible, or simply because breasts are not central to how they see themselves. Whatever you choose, we support you fully.

This uses a saline or silicone implant to restore breast shape and volume. Many patients also benefit from supportive “mesh”—either an absorbable synthetic mesh or a bioprosthetic mesh made from donated human dermis tissue—to help hold the implant in place and add soft-tissue coverage. 

A key decision is whether the implant sits above or below the pectoralis muscle: 

• Above (pre-pectoral) offers more natural movement and less animation deformity. 
• Below (sub-pectoral) provides extra soft-tissue coverage but can sometimes cause more discomfort or visible implant movement with muscle contraction.

We will discuss which plane best suits your anatomy and goals.

Implant based breast reconstruction can occur in either one or two stages: direct-to-implant (single stage) or tissue expander reconstruction (two stage). 

Direct-to-Implant means the final implant is placed at the same time as the mastectomy in a single stage. This is most common for prophylactic (preventive) mastectomies in women with youthful, non-ptotic breasts. If you have larger breasts and want a nipple-sparing direct-to-implant approach, Dr. Carpenter can first perform a staged breast reduction/lift to position the nipple and skin perfectly before the mastectomy.

Tissue expanders are the more common starting point for most mastectomy patients. A temporary expander is placed at the time of mastectomy and gradually filled with saline over weeks to months. This allows the skin to stretch gently before the final implant is placed.

“Autologous” means using your own living tissue to rebuild the breast. This can create a breast entirely from your own body or add healthy tissue when skin has been thinned or damaged by radiation. Common donor sites are the abdomen or back.

• DIEP Free Flap: Uses skin and fat from the lower abdomen while sparing the abdominal muscle. Blood vessels are reconnected under a microscope (microsurgery). 
• TRAM Free Flap: Similar to DIEP but includes a small portion of abdominal muscle. 
• TRAM Pedicled Flap: Uses abdominal skin, fat, and muscle that remains attached to its original blood supply and is tunneled to the chest. 
• Latissimus Pedicled Flap: Uses skin, fat, and muscle from the upper back, tunneled to the chest. Often combined with an implant for added volume.

Note from Dr. Carpenter: I perform pedicled latissimus and pedicled TRAM flaps in our practice. For women who are ideal candidates for a DIEP flap, I will refer you to a specialized academic center or a local microsurgery fellowship-trained plastic surgeon. If your breast surgeon is at Coral Springs Medical Center, I can place a tissue expander at the time of your mastectomy and, once chemotherapy and radiation are complete, seamlessly connect you with the right DIEP team.

Some women benefit from combining their own tissue (often a latissimus flap) with a small implant. This approach adds natural padding and volume while still using the implant for projection and shape.

After your initial reconstruction, we can refine results with additional procedures: 

• Nipple Reconstruction: Uses local skin to create a three-dimensional nipple projection—like a small origami fold. Many women feel more “complete” after this step. 
• Nipple Tattooing: Adds natural color to the areola. This can be done with or without surgical nipple reconstruction and can be performed by Dr. Carpenter or a specialized medical tattoo artist. 
• Fat Grafting: Liposuction from the abdomen, flanks, or thighs harvests your own fat cells, which are then carefully injected into the reconstructed breast. This fills contour irregularities, softens the look of implants, and creates a more natural feel and appearance. 
• Matching Procedures on the Opposite Breast: If you had a unilateral mastectomy, a lift (mastopexy), reduction, or small implant on the natural breast can create beautiful symmetry.