What Are The Options for Breast Reconstruction After Mastectomy​

Summary

You have two main paths forward:

1. Restore the breast mound using implants, your own tissue (flaps), or a combination approach, or
2. Choose an aesthetic flat closure for a smooth, natural chest contour without reconstruction.

From there, you may also choose to add nipple and areola reconstruction.

After my mastectomy, should I choose breast reconstruction or aesthetic flat closure?

Both paths are equally valid and survivor-affirming.

Rebuilding a breast mound: Many women choose to reconstruct right away (immediate) or later (delayed) after completing chemotherapy or radiation. This restores the breast contour and can help with emotional healing.

Going flat: Some women prefer to go flat for comfort, lower maintenance, or to minimize the number of surgeries. You can still use external prostheses or opt for 3-D areola tattoos for confidence, whether you're dressed or not.

Why this matters

Deciding early, in consultation with your breast surgeon, plastic surgeon, and radiation oncologist, helps align scar placement, skin preservation, and surgical timing for the best possible outcome.

Timing: immediate vs. delayed

Immediate reconstruction (same operation as mastectomy)

This preserves the natural skin "envelope" and can reduce your total number of surgeries.

Delayed reconstruction (months to years later)

Your medical team will recommend the best approach based on your tumor details and whether you'll need additional treatments.

This is common if radiation is planned or if you want time to heal and make decisions without rushing.

Why this matters

Radiation can change skin quality and affect healing. Many reconstruction plans use tissue expanders first, then finalize the permanent reconstruction once all treatments are complete.

Option A: Implant-based reconstruction

What it is

Silicone or saline implants recreate breast volume. You have two approaches depending on your tumor details, body type, and the quality of the skin and blood supply during surgery:

• One-stage direct-to-implant: implants are placed immediately after mastectomy during the same surgery.
• Two-stage with tissue expander: An expander is placed first to gradually stretch the skin, then replaced with a permanent implant during a second surgery.

Prepectoral placement (above the chest muscle) with mesh support is becoming increasingly common when appropriate.

Pros and cons

Pros:

• Shorter surgery time
• No additional body site scars
• Wide range of sizing options available

Cons:

• Radiation can increase risk of capsular contracture and implant malposition
• Need for implant surveillance

Aesthetx services for implant reconstruction

We provide implant-based reconstruction and specialize in breast revision surgery if you later develop rippling, capsular contracture, or implant migration. Our revision page outlines when to consider replacement or correction.

Why this matters

If radiation is likely in your treatment plan, ask your surgeon whether staging with an expander and delaying the final implant would protect your long-term outcome.

Option B: Autologous (“flap”) reconstruction

What it is

This uses your own skin and fat to build a soft, living breast mound. Tissue is commonly taken from:

• Abdomen (DIEP or TRAM flap)
• Thigh (PAP or TUG flap)
• Buttock (SGAP or IGAP flap)
• Back (latissimus dorsi flap)

The reconstructed breast often ages naturally with you, gains and loses weight along with your body, and typically tolerates radiation effects better than implants.

Note: Ask your surgeon which flap types they offer, as availability varies by center.

Pros and cons

Pros:

• Natural look and feel
• No implant maintenance required
• Better tolerance to radiation

Cons:

• Longer surgery and recovery time
• Additional scars at the donor site
• Not every body type or health history is a good match

Why this matters

Access to microsurgical flaps can be limited to certain regions. Ask whether your surgical center provides these procedures or partners with a specialized flap center.

Option C: Hybrid & adjunct options

Fat grafting

Fat is liposuctioned from one area of your body and carefully injected to soften edges or fill dents. This is often used to perfect contours after lumpectomy or reconstruction.

Latissimus flap + implant

This combination is often used in radiated breasts that aren't otherwise candidates for implant reconstruction, or after healing from complications from previous reconstruction. The latissimus flap brings healthy skin and tissue to recreate a breast mound, and an implant provides additional volume.

“Goldilocks” reconstruction

This technique reshapes existing mastectomy skin and tissue to create a smaller breast mound. It's ideal for those avoiding implants who aren't candidates for larger flap procedures. (Ask if your surgical team offers this option.)

Why this matters

Minor touch-ups with fat grafting can dramatically improve symmetry and softness without committing to a larger operation.

Nipples, areola, and sensation

If a nipple-sparing mastectomy wasn't possible, you have beautiful options to complete your reconstruction:

Nipple reconstruction options

• Surgical nipple mound: Created using a local flap (skin and tissue from the breast), provides projection of the nipple
• 3-D areola tattooing: Creates a remarkably realistic appearance

About sensation

Specialized centers may discuss nerve-sparing or nerve-reconnection techniques. Sensation varies depending on the reconstruction method and individual healing.

Why this matters

Many survivors say completing the areola is the moment their reconstruction feels truly "finished,” even if they've chosen to stay flat.

Symmetry procedures on the other breast

For unilateral (one-sided) breast cancer, achieving symmetry often involves adjusting the non-cancer breast. Depending on your goals and anatomy, options include:

Breast lift (mastopexy)

Aesthetx offers breast lift procedures, including auto-augmentation techniques that rearrange your own tissue for natural upper-pole fullness.

Breast lift with implants

If you want both lift and added volume in one surgery, this combined approach delivers excellent results.

Breast reduction

If you prefer a lifted, smaller, lighter breast that's more comfortable and better matched to your reconstructed side.

Why this matters

Symmetry procedures are sometimes covered as part of cancer reconstruction pathways. Ask your medical team and insurance provider what's included in your specific case.

Revision & maintenance: being honest about the journey

Reconstruction is often a process, not a single event. The journey typically includes:

• Tissue expander placement
• Exchange to permanent implant
• Fat grafting for refinement
• Nipple and areola reconstruction
• Occasional revisions

If you notice rippling, dimpling, migration, or unusual firmness years later, an experienced team can evaluate for capsular contracture or other issues and discuss breast revision options.

Your Priority	Lean This Way	Why
Fewer scars, shorter surgery	Implants	Shorter OR time; no donor site. Consider staging if radiation is planned.
Most natural feel; ages with you	Autologous flap	Living tissue often tolerates radiation better; longer recovery time.
Softening edges or filling dents	Fat grafting (adjunct)	Subtle refinements; can be repeated as needed.
Completing the look	Nipple surgery or 3-D tattoo	Beautiful options even if nipples weren't spared.
One breast affected (unilateral)	Lift / reduction / lift + implant	Balances shape and size with the reconstructed side.

Ready to Explore Your Options?

Expert Breast Reconstruction with Dr. Kamakshi R. Zeidler and Dr. Shirley Liu

At Aesthetx, breast reconstruction is led by a dedicated team including Dr. Kamakshi R. Zeidler, MD, FACS, and Dr. Shirley Liu, MD. Dr. Zeidler is a board-certified plastic surgeon with advanced microsurgical training from Stanford University Medical Center who specializes in reconstruction for BRCA-positive patients and cancer survivors. 

Dr. Liu is an experienced plastic surgeon with a strong focus on breast reconstruction and complex aesthetic outcomes. Both surgeons are known for a patient-centered approach, taking time to listen to your goals and partnering with each survivor to craft a plan that honors both medical needs and aesthetic vision.

Convenient Bay Area Locations: Los Gatos | Menlo Park | Marin County

Why Choose Aesthetx?

• Advanced Stanford-trained expertise in breast reconstruction
• Specialized in BRCA and cancer reconstruction with the latest techniques
• Comprehensive options: implants, fat grafting, revision, symmetry procedures
• Compassionate, unhurried care throughout your journey

Schedule Your Consultation 

Take the next step in your reconstruction journey. Dr. Zeidler and her team will answer all your questions and create a personalized treatment plan designed around you.