What Does a Reconstructed Breast Look Like?

How close can breast reconstruction get to creating a breast that looks real? Does it largely depend on how much tissue has been removed?

Doctor Answers 34

What do Reconstructed Breasts Look Like?

This is a simple question that has anything but a simple answer. Because there are so many variables involved, there is no single answer. Some of the variables that affect the appearance of reconstructed breasts include:

  • the timing of reconstruction (immediate-at the time of mastectomy or delayed-done at a second procedure sometime after mastectomy)
  • whether or not radiation therapy has been part of a women's treatment
  • the type of mastectomy performed (e.g., traditional incision, skin-sparing mastectomy or nipple spaing mastectomy
  • method of reconstruction (implants or natural-tissue reconstruction)
  • patient age
  • patient's skin quality and thickness.

The cliché, a picture is worth a thousand words, applies here. I suggest that you consult with board-certified plastic surgeons who have significant experience with breast reconstruction. Most experienced surgeons will have have a significant number of pre and postoperative photographs that you can review to get a better sense of what the results of reconstruction actually look like.

I hope this is helpful.

Breast Reconstruction Results

The results following reconstruction today can look very close to the real thing, but they will never look quite like a real breast because it is not a breast. It is very difficult to achieve the natural ptosis (hanging) or projection of a natural breast. In the past, the goal of reconstruction has been to make you look good in clothes, but plastic surgeons today really try to make an individual look good naked.

The amount of cancerous tissue and skin that must be removed does play a role. Other factors, including whether radiation therapy is needed, can also affect the outcome. The more mastectomy skin that can be saved, such as in a skin sparing (where only the nipple-areola complex is removed) or a nipple sparing (where the nipple-areola complex is spared), the more similar the reconstruction will be to the pre-mastectomy breast. Remember, adequately removing the cancer is the main priority.

Wandra K. Miles, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 2 reviews

How

Hi Eva,

Great question.

There are many factors that affect how good a breast reconstruction looks, many of which (unfortunately) are out of your plastic surgeon's hands. There are basically three components to breast reconstruction - there's the skin of the reconstructed breast, threre's the volume of the breast mound and finally there's the appearance of the nipple areolar complex.

  1. Breast skin. The best skin is breast skin - as in a skin sparing mastectomy when the reconstruction is performed at the same time as the mastectomy. If the reconstruction is "delayed" (ie you've had your mastectomy some time in the past) then new skin will be needed. This can either be created from the existing chest wall skin through tissue expansion, or can be recruited into the area in the case of a flap. Radiotherapy will cause discoloration and scarring of your chest wall skin, which makes the whole process trickier than in patients who haven't had readiotherapy.
  2. Breast mound. There are 3 ways to make a mound for a reconstructed breast. You can use an implant. You can use a flap of tissue from elsewhere in the body - usually either from the back or abdomen. Finally, you can use an implant under a flap
  3. The nipple areolar complex can be reconstructed by folding  the skin on the breast mound (sometimes with a skin graft) and then later getting it tatooed. Alternately, you can get adhesive (stick on) nipples which look very realistic.

Symmetry is the main goal of breast reconstruction. It is often easier to get good symmetry when both breasts are reconstructed in the same way at the same time. Matching a completely natural breast is not impossible - there will always be scars and slight differences - but it is a noble goal we all strive for.

Pleae check out some of the before and after photos on this and other websites.

Good luck with it all!

Get your reconstructed breast to look the best possible

I cannot emphasize enough, the best breast reconstructions are not just dependent on the plastic surgeon, you need a GREAT general surgeon or surgical oncologist. These are the types of surgeons that resect the breast tissue, and if they screw up or make bad choices, you are living with that, forever, mo matter how fabulous your plastic surgeon. First, you need the best incision. Only remove the nipple if you ABSOLUTELY have to. It;s well studied now that nipples can be left alone and there is no change in the cure rate, unless of course the tumor is actually in the nipple or right next to it. The best incision is under the breast, in my very opinionated opinion, because those side slashes look bad. Finally, ask the breast surgeon what their rate of mastectomy flap necrosis is. You may be shocked to hear that the average is 15%, and I have worked in the past with surgeons where it is as high as 40-50%. Horrible!! We are talking skin dying and turning blue and black and need to be cut off or getting infected. I've got to give a shout out to my friends at Bedford Breast Center in Beverly Hills whose doctors both have mastectomy flap necrosis rates of less than 1%. The closest you can get to real is to make great choices before the surgery.

Lisa B. Cassileth, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 12 reviews

Aesthetic Breast Reconstruction

That is a very good question.  There are many variables to answer that.  Much of how well a breast can be reconstructed is dependent on what tissue is left over after mastectomy.  The more aggressive the mastectomy the more difficult reconstruction can be.  Depending on what is expected you Plastic Surgeon may elect to use a tissue expander and implant based reconstruction or Autologous tissue.  Autologous tissue is using part of your own body to recreate a breast.  This is typically from your abdomen or your back.  You can really have great results with either form of reconstruction from an experienced surgeon.  What's great is that there has been more and more focus on bringing concepts from aesthetic breast surgery to reconstructive surgery, and patients have benefiting greatly from this.

I hope this helps :)

John Paul Tutela, MD
Livingston Plastic Surgeon
5.0 out of 5 stars 8 reviews

Cosmetic result of breast reconstruction

The result of your reconstruction has many influences.  The mastectomy surgery result, whether reconstruction is done immediately (time of mastectomy) or delayed, the role of radiation, your body habitus, and the appearance of the opposite breast amongst other things.  Also very influential is the type of reconstruction that is performed.  In most cases a reconstruction with your own abdominal tissue will provide a more natural look and feel to the breast.  However, implant based reconstructions can also look quite nice.  There are pros and cons to all surgery types that go beyond the final appearance.  Ideally your surgeon would perform all types of reconstruction and be able to guide you based on your individual situation.  

Rodger Shortt, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 34 reviews

It is supposed to look like the breast that you had removed but lifted!

I tell all of my patients that I can replace the volume usually without a problem.   Also the breast reconstruction cannot sag like a normal breast.  It has to sit higher so you always get a breast lift with a reconstruction.Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!


Breast Reconstruction Results

Results from a Breast Reconstruction are influenced by the following:

1.  Type of mastectomy performed (traditional vs. skin sparing vs. nipple sparing) determines the skin envelope of the breast.

2.  Size/Shape of breast prior to surgery.   Breasts that have a lot of loose skin are more difficult to reconstruct than those with less skin.

3.  Previous Breast Surgery:  patients that have had previous breast reduction or breast lift, may have limited options in mastectomy skin design and nipple preservation.

4.  Need for Radiation:  After radiation, patients will require removal of damaged skin and replacement with healthy non radiated tissue (patch appearance)

5.  Choice of Tissue Reconstruction vs. Implant Reconstruction:   Depending on your anatomy and potential donor sites, your plastic surgeon will share which of these options  may be able to achieve a more natural result in your setting.

 

Bottomline,  there are several options and factors that can influence a final breast reconstruction results.   In some cases, we can achieve very natural results and even improve on the existing breast shape and size.    In others, we are limited in options based on the breast anatomy, presence of radiation, or mastectomy performed and must realistically discuss what to expect prior to surgery.


I think the most important part of breast reconstruction is establishing expectations prior to the procedure.   With the many doctor visits and different options on the table, it is often difficult to absorb what the limitations of reconstruction can be.    However, I find a good understanding of this prior to surgery, leads to a happy and well informed patient postoperatively.    I wish you a safe recovery and wonderful result.

 

Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
5.0 out of 5 stars 75 reviews

It Depends on the Mastectomy itself

The appearance of a reconstructed breast depends a lot on the mastectomy itself. Factors like the amount of skin and tissue that was removed and whether a nipple-sparing approach was used will affect your results. Your plastic surgeon can only work with what he or she has been given, which is one reason why it is important to include your plastic surgeon at the beginning of the process, not after the mastectomy is already completed.

That being said, women today can achieve beautiful, very natural-looking results with reconstruction, particularly with the use of flap reconstruction (using the patient’s own tissue) in combination with implants.

David N. Sayah, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 6 reviews

Appearance of Reconstructed Breast

Dear Eva - The answer to that question depends on so many things: whether the reconstruction is done immediately or delayed, what type of method is used ie tissue expander versus latissimus dorsi versus DIEP, whether you have radiation therapy, etc.  In general, yes the more skin removed the harder it is to make a natural breast.

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.