Breast Reconstructive Surgery

Choosing if and how to restore your breasts after a mastectomy puts you back in control of your body. We can help you feel whole again after breast cancer.

What is Breast Reconstruction Surgery?

Breast reconstruction is a major surgery that restores your breasts after mastectomy. We offer both implant and autologous tissue flap reconstruction as part of your overall breast cancer treatment plan.

You’ll meet with your breast cancer surgeon after your initial diagnosis to discuss your treatment plan. From there, you’ll have the option to consult with a breast reconstruction surgeon.

Your reconstruction surgeon will walk you through your options — including autologous breast reconstruction (e.g., DIEP flap) and implant procedures. They’ll also discuss the possibility of not having reconstruction.

Once you make your decision, your breast cancer care team will work with you and each other to plan your surgery.

Choosing the Right Breast Reconstruction Surgery 

Breast reconstruction is a highly personal choice. We’ll walk you through each step of your decision — helping you land on the right option for you.

Our Penn Medicine | Virtua Health team will help you choose the best option based on:

• The size of your breasts
• The condition of your skin
• Your previous breast cancer treatment
• Your body type
• Your preferences (e.g., size, shape)
• Your overall health

Mastectomy and reconstruction at the same time 

At Virtua, you can typically have breast reconstruction surgery at the same time as your mastectomy. Your breast surgeon and plastic surgeon work together — and with you — to plan your surgery.

During the procedure, your surgeons will work in parallel. As your breast surgeon removes the breast, your plastic surgeon will be preparing for the reconstruction. They’ll begin reconstruction when your breast surgeon works on the other breast.

The benefits of breast reconstruction at the same time as mastectomy are:

• Less time under anesthesia, which decreases the risk of side effects from anesthesia
• Fewer surgeries
• Less time in the hospital overall
• Faster recovery 

Types of Breast Reconstruction Surgery after Mastectomy at Virtua 

Penn Medicine | Virtua Health reconstructive surgeons are fellowship-trained in breast reconstruction and microvascular surgery. Microvascular surgery is a highly specialized technique that uses tissue from one part of the body to reconstruct another.

With this level of expertise, we offer all breast reconstruction options at Virtua, including:

• Implant procedures: Implant breast reconstruction is the most common breast reconstruction surgery. It consists of one or two procedures that use saline or silicone breast implants.
• Autologous tissue flap reconstruction: Flap procedures are microvascular surgeries that uses tissue from your belly, buttocks, or thighs to reconstruct your breasts.

Expander implant breast reconstruction

Most patients at Virtua have expander implant reconstruction, which consists of two separate surgeries.

Expander implants are a good option if you:

• Have not had previous breast cancer treatment (e.g., radiation, lumpectomy)
• Want to increase the size of your breasts
• Have an underlying condition (e.g., diabetes, lupus) that may affect your body’s ability to heal
• Do not have enough skin and tissue on your breasts after mastectomy to support an implant immediately

During your mastectomy, your plastic surgeon will put in tissue expanders. You can typically go home the same day as this procedure.

Over the next three or four months, you’ll begin the expander process to prepare for implants:

• You’ll have weekly appointments at Virtua to slowly stretch your skin.
• We’ll do this by filling the expanders with liquid or air until you get to the size you want.
• You’ll then have a second procedure to receive your implants, and you’ll be recovered within two weeks.

Direct to implant breast reconstruction 

You may have the option to have implants put in at the same time as your mastectomy.

You’ll typically go home the same day as this procedure. And you will be fully recovered within three to four weeks.

Direct to implant reconstruction may be an option if you:

• Have not had previous breast cancer treatment (e.g., radiation, lumpectomy)
• Do not want to increase the size of your breasts
• Do not have any underlying conditions
• Have enough skin and tissue on your breasts after mastectomy to support an implant immediately

Belly tissue flap reconstruction 

At Virtua, the majority of flap reconstructions use tissue from your belly to rebuild your breasts. During your mastectomy, your plastic surgeon will remove tissue from your belly and use it to reconstruct your breasts.

While different than a tummy tuck, you will get the benefit of a flatter belly with this technique.

After your procedure, you’ll recover in the hospital for about three days. And you’ll be fully recovered in about six weeks.

This may be a good option if you:

• Have had previous breast cancer treatment (e.g., radiation, lumpectomy)
• Have excess tissue on your belly

Depending on your body type, your surgeon will use one of these flap techniques:

• DIEP flap: Uses tissue from your lower abdominal, and includes a small incision on your abdominal muscle
• TRAM flap: Uses tissue from your lower abdominal and part of your abdominal muscle
• SIEA flap: Uses tissue from your lower abdominal but does not involve your abdominal muscle

Buttock or thigh flap reconstruction  

While less common, your plastic surgeon can also remove tissue from your buttocks or thighs to reconstruct your breasts.

Similar to belly tissue flap reconstruction, this can be done during your mastectomy. And recovery takes about six weeks.

This may be a good option if you:

Have had previous breast cancer treatment (e.g., radiation, lumpectomy)

Have had abdominal surgery in the past

Do not have enough excess tissue on your belly

Depending on your body type, your surgeon will use one of these flap techniques:

• S-GAP flap: Uses tissue from your upper buttocks
• I-GAP flap: Uses tissue from your lower buttocks
• TUG/TMG flap: Uses tissue from your upper thigh 

Breast Reconstruction Surgery after Lumpectomy at Virtua

Sometimes breast cancer treatments like lumpectomy and radiation therapy can change the size and shape of your breast. That’s why Virtua also offers you a way to restore the look and feel of your breasts after a lumpectomy.

In collaboration with your breast cancer surgeon, our plastic surgeons perform oncoplastic lumpectomies. This is a specialized surgery that combines breast cancer surgery with cosmetic surgery techniques.

During this procedure, your surgeons will first remove the breast tumor. They will then reshape your breast to restore its natural shape and symmetry.

Depending on your preferences, you can also choose to have a breast reduction at the time of your lumpectomy. 

The Virtua Difference for Breast Reconstruction Surgery 

• High volume of breast reconstruction surgery: We perform more autologous breast reconstruction procedures than any other center in the U.S. This level of expertise helps our patients heal and recover from surgery with few complications. It also results in natural-looking breasts that have helped our patients look and feel like themselves after breast cancer treatment.
• Pre-pectoral approach for implants: Penn Medicine | Virtua Health plastic surgeons specialize in pre-pectoral implant reconstruction. Traditional implants go under the pectoral muscle, which is often painful and can cause changes in breast shape. Pre-pectoral implants go over your muscle, which is significantly less painful. This means you can go home the day of surgery rather than staying overnight in the hospital for pain management. It also ensures that your reconstructed breasts maintain their shape long-term better than traditional implants.
• Pain management after surgery: We focus on helping you recover quickly after breast reconstruction. We do this by incorporating enhanced recovery after surgery (ERAS) methods. This includes drinking carbohydrate fluids before surgery and getting out of bed quickly after surgery. These steps help your body prepare for surgery and regain normal function after surgery. We also send you home with a continuous infusion pain pump, which automatically releases pain medications for three days after surgery. Since implementing this regimen, our patients have reported significantly decreased pain after surgery.
• Breast reconstruction after radiation: Implant breast reconstruction is not typically an option if you’ve had previous breast cancer treatment (e.g., lumpectomy, radiation therapy). But at Virtua, we can work with you to determine options that can restore your breasts with your own tissue with a wide range of flap procedures.
• Revision surgery: If you have had previous reconstruction or are not happy with the results, we offer revision breast reconstruction surgery. During this procedure, we can address pain, infection and/or poor cosmetic results (e.g., change in size, shape or position).
• Nipple tattooing: After breast reconstruction, we offer nipple reconstruction with micropigmentation, also known as nipple tattooing. The tattoo won’t be raised, but the coloring and shading of the tattoo will give the appearance of a natural nipple. There is minimal to no pain involved and you can go home the same day.