Options for Reconstruction After Bilateral Mastectomy?

After a bilateral mastectomy has been performed, what breast reconstruction options will provide the most natural look?

Doctor Answers 14

Options for reconstruction after bilateral mastectomy?

Hello!  Thank you for your question. Arguably, flap reconstruction provides the softest, most naturally-appearing breasts that look, feel, and move most like a natural breast.  They can also be contoured afterwards to shape the breast via fat grafting - allowing you to have tissue completely from you, without the need for a prosthetic device.

They also provide other advantages - after radiation, you have an increased rate of complications including wound problems, infections, thinning of the tissue, and decreased vascularity to the skin/tissue of the area.  The best method to reconstruct a breast following radiation therapy is with a flap.  The flap, which is skin, fat, and sometimes muscle, will serve to bring in healthy, well-vascularized tissue to the chest/breast area that will significantly ameliorate the radiation issues compounding the problem.  Microsurgical perforator flaps (such as the DIEP flap and SGAP/IGAP flap) are the newest and most-innovative procedures in breast reconstruction today.  As these are muscle-sparing flaps, the pain, morbidity, and complications such as those above, of these procedures are much less.  They are highly-complex procedures that few plastic surgeons performed and consult with one who is well-versed, trained, and skilled in these procedures if you are interested.  

There are many options to breast reconstruction including implant-based and flap-based procedures.  The complication rate with implants following radiation is reported as high as 60-70% in some studies.  Flap reconstruction is usually recommended, but there are several centers who perform implants following radiation with great success and results.  I typically prefer flaps, such as the DIEP flap.  Other flaps are the conventional TRAM, latissimus flap, SGAP/IGAP, and, TUG.

You are a candidate for other procedures, if you are willing to continue with your journey for a reconstructed breast.  Flaps such as those above, including others, are available.  The decision to continue with this will be your decision and what you are willing to go through.  There are risks and benefits with everything that we do in Surgery - discuss the various options with a board certified plastic surgeon who will educate you on all of the options and help you to decided if breast reconstruction or which procedure will be best for you.  Hope that this helps and best wishes!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 24 reviews

Natural Breast Reconstruction

The most natural reconstruction option, is one that is not known by most plastic surgeons.  Yet.  It is fat transfer to the breast with the external expander BRAVA.  This process uses your own fat to rebuild entire breasts.  We use no incisions and no foreign objects, and in most cases, it is an outpaitent procedure.  We are pioneers in the use of large-volume autologous fat transfer. 

For anyone who has gone through a cancer diagnosis, the difficult task of
undergoing major surgery, and sometimes the unpleasantness of radiotherapy or
chemotherapy, the thought of one or more major traumatic operations to reconstruct
her breast is exhausting. The fact that this fat grafting technique is now an option is a
giant breath of fresh air.When one adds the additional benefit of body sculpting through
the liposuction, hope for a normal, natural life begins to take hold.


Breast reconstruction can involve implants, the body's own tissue (a flap) or a combination of these options

After a mastectomy for breast cancer or for risk-reducing surgery (BRCA gene positive women or those who wish to reduce their personal risk of breast cancer), there are a variety of options for breast reconstruction:

  • Nipple-sparing mastectomy - provides the most natural results and allows reconstruction of the entire breast in a single operation
  • Implant-based reconstruction - I specialize in a single-stage approach using adjustable permanent implants
  • Flap-based reconstruction - using the body's own tissue to build a new breast, usually making use of extra skin and fat from the lower abdomen (DIEP or SIEA flap) or the inner thigh (TUG flap).  Tissue is transplanted Microsurgically in my practice, sparing major muscles of the body like in the TRAM or the LD flap.
  • Sometimes, a combination of a flap + an implant is done with the procedures staged 6 months apart.  This will bring healthy new tissue to an area in need of a flap (for instance, after radiation or severe infection) and the implant will "augment" the flap, similar to a breast augmentation.

I encourage you to seek a Board-Certified Plastic Surgeon who specializes in breast reconstruction and who can offer you the full spectrum of options, including implants and Microsurgical procedures. 

The goal in my practice is to achieve above all else a NATURAL reconstruction that best matches a woman's particular aesthetic goals.  Please visit my website for more educational background information.

Karen M. Horton, M.D., M.Sc., F.A.C.S., F.R.C.S.C.

Karen M. Horton, MD
San Francisco Plastic Surgeon
3.9 out of 5 stars 9 reviews

Breast Reconstruction

This requires your visiting a Board Certified Plastic Surgeon or surgeon who does a lot of these and can explore all your options.  They will need to examine you and offer advice based on your previous therapy and what options are best for you now.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 25 reviews

Bilateral Mastectomy Reconstruction

The two major categories for breast reconstruction are 1) implant-based and 2) autologous (using your own tissue). With proper patient selection, we obtain outstanding results with both modalities. However, reconstruction is a process that requires some steps to achieve the best results.

Options will include Saline/Silicone Gel implants, Autologous reconstruction with DIEP or SIEA or TRAM flaps, etc. There are pro's and con's to each option. No single reconstruction is the best for everyone. If you have excess tissue in your lower belly (i.e. have you ever thought you might beneft from a tummy tuck?), then you may be a good candidate for a DIEP free flap (reconstructing your breast using your own tissue without the need of an implant).

We often visit with out of town patients to help them with their reconstructive journey.  And we work with several outstanding breast surgeons to facilitate immediate reconstruction for out of town patients. Please visit our breast reconstruction website listed below to learn more about your options.

Best wishes.

Dr. Basu


Most Natural Look after Bilateral Mastectomy

In my opinion, the most natural look and feel will come with use of your own tissue for reconstruction.    In order to perform this procedure, you must have an adequate donor area to provide you with your desired cup size.   The most common donor site is the abdomen, where we typically perform a muscle preserving DIEP Flap.    Other donor sites include the buttocks (GAP Flap) and Inner Thighs (TUG Flap).    

If you are not a candidate for tissue reconstruction, I would then recommend a silicone gel implant breast reconstruction with 2nd stage fat grafting to provide a smooth contour.      However, if your cancer treatment involves radiation, this procedure would be contraindicated.

I wish you a safe and happy reconstruction process.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 83 reviews

Breast reconstruction options

There are many forms of breast reconstruction options including using autologous tissue usinf perforator flaps, other forms of free flaps, as well as pedicled flaps like a TRAM.  Other forms of reconstruction include tissue expanders and then exchanged for implants.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Breast reconstruction

the most natural look is with your own  tissue, but that will depend on your doner site availability.  it also means a longer operation. i generally suggest that you start with expander /implant reconstructions.  they are easier on you and symetry is fairly easy to achieve. all reconstruction choices have their own set of complications. find an experienced surgeon in your community and he will help you with your choices

Jonathan Saunders, MD
Newark Plastic Surgeon
4.7 out of 5 stars 59 reviews

Bilateral breast reconstruction options

As a presumably non-radiated patient, you have all options open to you.  Tissue reconstructions can be shaped and reshaped and feel warm and natural.  These are the best reconstructions in the right candidate but involve more scars and much more technical skill from the surgeon.  Bilateral implant reconstructions are easier and can usually look reasonably symmetrical too.  Implants carry long-term baggage like scar tissue, deflation/rupture.  Make sure you see surgeons who can offer ALL the options including microsurgery so the very best for you can be determined.  Good luck!!

Immediate bilateral DIEP flap or other autologous breast reconstruction

If you are looking for the most natural result,autologous breast reconstruction is the best option. You will get the best cosmetic result if your oncologial breast surgeon can do nipple sparing mastectomy and get immediate DIEP flap reconstruction. All depends on your breast cancer and if you need radiation after mastectomy. You can send more information about your breast cancer stage and your pictures for more evaluation. I prefer DIEP flap since your abdominal muscle left intact unlike TRAM flap that uses abdominal muscle.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 112 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.