There are a number of breast reconstruction options after undergoing a single or double mastectomy. Some women opt not to get reconstruction and can choose to get a prosthesis. Determining which option is the right choice for an individual is based on numerous factors, including: whether the surgery is prophylactic or due to having breast cancer, if the individual is a candidate for nipple sparing (“subcutaneous”), chest size, and age. The decision will be made based on a discussion with your plastic surgeon who will recommend one (or potentially a few) option(s) based on your unique case.

There are three that my surgeon discussed with me, although he only recommended one. Regardless of which of the below approaches is taken, breast sensation is permanently lost in the mastectomy breast(s).

1. Tissue Expander Implant: This is the “easiest” option of the three, comparatively, and the path that I’m taking. The hospital stay and recovery time is the shortest and there are no additional scars beyond the scar from the mastectomy, but it does take at least two operations. Also, there is flexibility in selecting the final breast size in bilateral cases (more on this below). Additional details can be found here.
2. Latissimus Flap +/- Implant: This involves transplanting an oval flap of skin, fat, muscle, and blood vessels from your upper back to the chest wall which is used to reconstruct the breast. This option requires an additional night or two in the hospital compared to the Tissue Expander Implant and the recovery time is a few weeks longer. There will be additional scars on the patient’s back and a circle on the affected breast(s). A more eloquent explanation of this can be found here.
3. Abdominal Tissue (TRAM, DIEP, SIEA): Essentially this involves transplanting excess flesh/tissue from the abdomen to the chest wall and using that to reconstruct the breast. This is the most involved option with an average hospital stay of three to four days, the longest recovery time, and additional scars on the patient’s lower abdomen and a circle on the affected breast(s). The one upside with this option is that due to the excess flesh/tissue taken from the abdomen, the patient also essentially gets an abdominoplasty (aka, flat abs). Again, a more eloquent explanation of this can be found here.

As mentioned above, I did the Tissue Expander Implant. Based on my physical build, weight, chest size pre-surgery, and because the surgery was prophylactic, the doctors were able to put the expanders in during my initial surgery immediately after Dr. Bethke (the breast surgeon) and his team removed all of the tissue. This is called immediate reconstruction whereas some women have to get this done in two surgeries.

Now that my drains are removed and my body has had about 2.5 weeks to heal, I should be able to start my fill appointments with the plastic surgeon, Dr. Fine. I go in once a week for these fill appointments during which Dr. Fine will inject a small amount of saline solution into each of the expanders. The maximum frequency allowed for these visits is once per week. This approach is taken to allow the skin to stretch a little at a time and even with this small amount there is still pain and discomfort following the appointment. Once I reach the size I want, I stop going in for these appointments. On average, if one goes in weekly, it takes 1 to 1.5 months. These appointments can be spaced out further to every two or three weeks, which some women who are also undergoing chemotherapy during this time may opt to do. Regardless of when I reach my ‘ideal size’, the earliest I can get the final surgery is three months post-op (so sometime early February). My first fill appointment is tomorrow.

There is one other step to the reconstruction which is the nipple reconstruction. Some women are candidates for a nipple sparing mastectomy (or subcutaneous mastectomy), where the nipple is not removed. There are different criteria that the breast surgeon considers, such as chest size pre-surgery and whether or not the woman had/has breast cancer (I know there are exceptions to this). Subcutaneous mastectomies are less common as some tissue is left behind which could later develop breast cancer (although the probability of getting it is < 2 to 3%). For women who have to have the nipple removed (simple or total mastectomy) they have three options for reconstruction.

1. Using Tissue: In a separate surgery, the doctor makes a small incision on the breast, raising the tissue and forming it to mimic a nipple. You can then get the areola tattooed on, if desired.
2. Nipple Tattoo: There are certified medical tattooists who specialize in 3-D nipple tattooing (Vinnie Myers is the most well known, who is also a former Army medic). You can find examples of their work online which I find both fascinating and impressive.
3. No reconstruction