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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.* 

From the emotional toll to a whirlwind of appointments, testing, and treatment options, a breast cancer diagnosis can bring a flurry of confusion and fear. Each aspect comes with its own impact — not only on a woman’s health, but on her sense of self. Fortunately, early detection and advances in both technology and surgical techniques have created better breast reconstruction options that help patients to feel like themselves again. 

To better understand the intricacies of the mastectomy and breast reconstruction process, The AEDITION spoke to leading plastic and reconstructive surgeons and their patients about the logistical, physical, and emotional aspects of breast reconstruction — whether it’s finding the right surgical team, understanding what the results will look like, or learning how to heal (physically and emotionally) after surgery. 

## **Finding the Best Surgical Team**

Although it can be hard for a woman recently diagnosed with breast cancer to focus on the long term, the success of her breast reconstruction may ultimately depend on it. “Some patients are so focused initially on getting the cancer out that they don’t really explore the options for reconstruction,” cautions plastic surgeon [Michael Newman, MD](https://aedit.com/provider/michael-newman-md-795), of South Bay Plastic Surgeons in Torrance, CA. “But then they get to that stage when the cancer is out, they’re feeling better, and they really want a better result.” 

When that happens, they often try to find another surgeon, and Dr. Newman says he treats a fair number of patients seeking a revision after surgery elsewhere. While he is able to help the majority of such patients, it is not the most optimal way to do things. 

“There are a lot of breast surgeons who don’t leave the best tissue behind for the plastic surgeon to work with. When there’s a limited amount of tissue to work with, even the best plastic surgeon can’t do a great job,” he says. “It’s better to optimize their reconstruction from the beginning because they end up with a better final result.”

In order to do so, Dr. Newman recommends women take the time to find the best breast surgeon, so they can “set the stage for an ideal reconstruction.” In a perfect world, he says patients should visit a plastic surgeon at the outset to get a referral for a breast surgeon (though it generally happens the other way around). But, if a patient has already chosen a breast surgeon, Dr. Newman suggests asking her plastic surgeon if that doctor is someone they’ve worked with in the past.

The key, according to Dr. Newman, is to find a breast surgeon capable of achieving a balance between removing all of the breast tissue and leaving an adequate amount of skin, fat, and blood vessels behind to support the reconstruction. And he says you shouldn’t be shy about asking your breast surgeon about their experience level and their philosophy regarding tissue removal. 

Another piece of advice? Find support.

Dr. Newman advises women to seek out breast cancer support groups (often offered at hospitals) for advice on which doctors to choose. “When you talk to other people who have been through it, they’ve not only had their own experiences, but they’ve heard from other people too,” he shares. 

Once you’ve found your team, the next step is determining the best course of action for your diagnosis. 

## **Removing the Cancer: Lumpectomy vs. Mastectomy**

Deciding on a breast cancer treatment plan often depends on the type and stage of the cancer, the philosophy of the doctors, and the patient’s own goals and preferences. 

During a lumpectomy procedure, a breast surgeon removes only the tumor, leaving the rest of the breast tissue intact. Less invasive than a mastectomy, a lumpectomy may not have a noticeable impact on the size and shape of the breast — though a growing number of patients are opting to combine the procedure with aesthetic surgery.

“Women with very large breasts who are getting lumpectomy surgery sometimes are getting [breast lifts](https://aedit.com/procedure/breast-lift) or [breast reductions](https://aedit.com/procedure/breast-reduction) as part of that surgery,” says Dr. Newman. “It’s either to make them feel more comfortable, more symmetric, or to facilitate their secondary treatment such as radiation.”

Additionally, Dr. Newman has noticed that younger women are increasingly choosing to undergo a mastectomy — either unilateral (one breast) and bilateral (both) — during which the surgeon removes all of the breast tissue (read our comprehensive guide to the surgery [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer)). “As breast reconstruction results have improved, patients are more likely to move towards a mastectomy or even a double mastectomy than they had in the past,” he says. 

Historically, surgeons removed the breast tissue, nipple, and much of the skin, but the rise of nipple- and skin-sparing procedures have been game-changers for breast reconstruction results. During a nipple-sparing mastectomy, the breast tissue is essentially scooped out, leaving the outside of the breast (nipple and skin) virtually intact. “You don’t have to sacrifice the most difficult aspect of the breast to reconstruct,” says Nashville-based plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), of the technique. “To create a nipple, you either need to get a tattoo, which leaves no projection, or reconstruct one, which leaves scarring in the center of the breast.” 

According to Dr. Unger, who performs several hundred breast reconstructions per year, data shows that, in most cases, leaving the nipple and skin intact does not adversely impact a patient’s long-term prognosis — but it can do wonders for the post-surgery outcome. Sparing the nipple and concealing the surgical scar in the breast fold allows surgeons to create the most natural-looking results. 

## **Types of Breast Reconstruction**

Generally speaking, there are two categories of breast reconstruction: implant-based and autologous tissue (a.k.a. flap)-based.

- __Implant__: Most commonly used thanks to its shorter surgical and recovery time, implant-based reconstruction can be performed in conjunction with a mastectomy or at a later time and involves using an implant to recreate the breast. 

- __Autologous Tissue__ (a.k.a. Flap): In this procedure, the surgeon utilizes the body’s own tissue to construct a breast mound by transferring tissue from one area of the body (known as the donor site) to the chest.

Sometimes, a combination of the two is used to achieve the most natural, symmetrical results. “I want all of my patients to understand their options so that they can make the best choice for them,” says Dr. Unger. “And then my job is to give the best result I can under those constraints.”

Creating a natural *and* symmetrical result can be challenging — regardless of the type of mastectomy or breast construction technique performed. In patients who opt for a unilateral mastectomy with an implant, for example, it is difficult to match real breast tissue to the standard shape of an implant. 

A patient’s unique anatomy, meanwhile, can pose challenges for reconstruction after a bilateral mastectomy, too. “People aren’t always even between their two sides,” UCLA plastic surgeon [Jason Roostaeian, MD](https://aedit.com/provider/jason-roostaeian-md-449), points out. “We want the best aesthetic results, but there are a lot of variables out of our control: how the mastectomy was performed, whether they are planning to have radiation, the structure of their ribcage — all of these things that nobody really ever thinks about.”

While surgeons take all of these nuances into account, there’s no such thing as perfection. In fact, relying solely on measurements — particularly for things like nipple placement — can leave a patient with an unnatural result. “The good news is that since nobody is perfectly symmetric, it’s more about making each breast look good on its own,” says Dr. Roostaeian. “They are sisters, not twins.” 

Ultimately, the surgeon’s well-trained eye is paramount because the reconstruction process is equal parts art and science, and managing a patient’s expectations is key. “Women who are undergoing breast cancer care today are expecting and hoping for results similar to aesthetic breast surgery,” says Dr. Unger. “It’s about having appropriate expectations and having good lines of communication.”

## **The Emotional Impact of Breast Reconstruction**

While a successful breast reconstruction can have a tremendous impact on helping women start to feel whole again after a cancer experience, the path isn’t always smooth or linear. It is not uncommon for reconstruction patients to experience some degree of post-surgery depression and seeking help through support groups or therapy can make a big difference. 

Dr. Roostaeian’s patient Marjan was ultimately very happy with her flap surgery, but it was emotionally challenging at first. “I started getting really emotional,” she says of her experience, which included a flap procedure, refining surgery, and nipple reconstruction. “I was regretting not getting the double mastectomy because I was afraid I’d have to go through all of this again.”

Initially, she says that every time she saw herself in the mirror, her unaffected breast reminded her of what she’d lost, but Marjan sought therapy and eventually came to terms with her new appearance. “I changed my perspective, my outlook on body image,” she shares. “When I see people now who look different, it doesn’t phase me. It’s just normal.”

Hayley, meanwhile, chose a pre-pectoral, direct-to-implant reconstruction in part because she wanted to be done with the process sooner. “I wanted to move on with my life, to feel like my old self again,” she says. But months after her treatments, Hayley experienced symptoms that her oncologist said were long-lasting side effects of everything her body’s been through. “Even though I know that I’ll never truly be my old self after going through something really scary, I grew a lot from it,” she says of her experience.

Caroline* also went through a period of conflicting emotions after her reconstruction. “It hit me at the end,” she says. “You’re so focused on getting through all of the terrible parts — mastectomy, chemo, radiation — to reach this goal of reconstruction, and, when you get there, you have to come to terms with the fact that no matter how well they put you back together, it’s not the old you. You have to learn to embrace the new you.”

One thing that can help give patients peace of mind is knowing that they had the best care. Dr. Unger’s implant reconstruction patient Laura, who chronicled her breast cancer journey on [Instagram](https://www.instagram.com/laura_birdwell/?hl=en) and her [blog](https://tatatocancer.blog/), says that finding the right plastic surgeon helped her get through an otherwise incredibly challenging time. “When you’re going through everything, and you’re losing your hair, it’s just such a comfort,” she says. “I call him ‘the good doctor.’”

Kelly feels the same way about the rapport she built with her own plastic surgeon, [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578). “It’s really important to educate yourself and to find someone you trust,” she says. “It’s a relationship, not a ‘one and done.’” 

*Patient names have been changed

Expert Opinion

The AEDITION speaks to leading plastic and reconstructive surgeons and patients about the logistical, physical, and emotional aspects of breast reconstruction — from finding the right surgical team to learning how to heal after surgery. 

How To Approach The Post-Mastectomy Breast Reconstruction Process

How To Approach Post-Mastectomy Breast Reconstruction

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

[According to the World Cancer Research Fund](https://www.wcrf.org/dietandcancer/cancer-trends/breast-cancer-statistics), breast cancer is the most commonly occurring cancer in women worldwide and the second most common cancer overall globally, with two million new cases in 2018. In the United States, [it is estimated](https://www.breastcancer.org/symptoms/understand_bc/statistics) that one in eight women (or approximately 12 percent of the female population) will be diagnosed with breast cancer in her lifetime. 

The mastectomy plays a large role in the prevention and treatment of breast cancer, and, while The AEDITION has covered what to expect before, during, and after the surgery from a medical perspective (more on that [HERE](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer), calling attention to the emotional toll of choosing to remove one or both breasts is just as important.

Here, two women share their deeply personal and resilient experiences with breast cancer, mastectomies, and breast reconstruction. 

## __Rena, 53__
In a six-month period, Rena’s relationship with her body and her breasts completely changed. Her breast cancer diagnosis and subsequent unilateral mastectomy happened very quickly, and she was forced to face her new reality much sooner than expected. Rena made the decision not to undergo breast reconstruction and quickly learned that the subsequent transformation was more emotional than physical. 

“The emotional scars take much longer to heal than the physical scars do,” she shares. “The breasts are symbolic of so much. They’re symbolic of feminine beauty and motherhood. Breasts come with a lot of baggage.” 

Following her mastectomy, Rena felt deep waves of emotion that resembled grief, pain, and sadness. “There was a point after the mastectomy where I genuinely thought I was losing my mind because I was so sad. I felt so unwell. I was in a lot of pain. I didn’t really want to leave the house,” she recalls. “And now I look back at that and go, ‘Of course.’ Grief is going to come your way, and you can name it. Now if I feel sad, I go, ‘Oh yes, grief. I know what that is. It’ll be gone tomorrow. Just having a sad day.’ I don’t have that, ‘Oh my god, I haven’t just lost my breast, I’ve lost my mind’ feeling.”

<PullQuote attributedTo={Rena, 53}>
  “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”
</PullQuote>

Rena says the emotional labor was hard, but learning to sit with it and honor how she was feeling was key. She allowed herself to feel her emotions and didn’t pressure herself to feel strong all the time. The driving force of Rena’s recovery came when she stopped letting the situation control her and instead could respond to what was happening around her.

“Take control of what you can,” she explains. “Take an empowered approach and come from a place of strength. You get to decide when you want to take the next steps and how your mastectomy process goes.”

In the moments before her surgery, for example, Rena insisted on walking into the operating room instead of being wheeled in by the nurses. When she got home, she turned all the full-length mirrors in her house around until she decided she was ready to look at her body again. 

Her advice to those on a similar journey: “As soon as you get that news, the time is now to start saying goodbye to your breasts and thanking them for everything they’ve meant to you and done for you,” she says. “Quickly get it into your head that it’s your choice to do away with your breasts in exchange for your life. I chose to sacrifice my breast in order to live. I know that’s sad, but you can say, ‘I will be sad to lose my breasts, but I want to live.’”

## __Tracey, 45__
Like Rena, Tracey has been on her own unique journey. Her diagnosis was a long time coming because she knew she was at risk of developing breast cancer and was able to anticipate at least part treatment and recovery. Due to her family history of breast cancer, she was screened regularly for the disease and discovered she carried the BRCA1 gene mutation in late 2010. She decided she would preventatively have her ovaries removed and undergo prophylactic (a.k.a. preventative) mastectomy and breast reconstruction procedures at the same time.

“If I just had a mastectomy, I know I personally would not have felt feminine,” she shares. “Because I was doing elective surgery, I was lucky enough to be able to consider this option and have the two procedures done together.”

Opting for an immediate reconstructive surgery gave Tracey the opportunity to feel like she was reclaiming power over her experience, but, post-mastectomy and breast reconstruction, she experienced a series of complications and side effects that prolonged her recovery time.

<PullQuote attributedTo={Tracey, 45}>
  “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”
</PullQuote>

“A few days after the procedure, my cosmetic surgeon noticed that my right nipple wasn’t going to survive, so I had to be taken back in for surgery to remove it. After about a month at home, I got really sick due to an infection in the right breast, and I had to be rushed to the hospital to get the expander out,” she explains. “All up, I think I’ve had about six or seven surgeries now — this includes having the implants put in and a nipple reconstruction on my right breast, which looks great. My left breast is perfect and I’m happy with it. The right one, not so much. But who is ever happy with the way their breasts look? Even naturally, they’re different. I continue to see my plastic surgeon once a year for a follow-up.”

While her road to recovery was a winding one, she remains upbeat about the results. “I’m not affected by it from day to day. Yes, my breasts are hard, one is quite scarred, and one nipple is bigger than the other, but did I make the right decision? Absolutely, 100 percent,” she says. “To look at me, you would never know that I’ve had a mastectomy and reconstruction and that I’m going through menopause. I still feel like me.”

Tracey’s advice to anyone who is considering a preventative procedure or currently undergoing treatment: “I think it’s a personal journey. Everyone is different and has different feelings and expectations,” she says. “My only advice would be to ensure that you do go through all the options of the procedure, have a great surgeon, and surround yourself with a good support group and care team. Try to be positive as much as you can and reassure yourself with the reason why you’re going ahead with these procedures.”

## __The Takeaway __
Rena and Tracey’s experiences prove that there is nothing linear about breast cancer diagnoses and treatment, but hearing from survivors and those who have elected for preventive mastectomies helps to shine a light on the fact that — regardless of your circumstances — the experience is as emotional as it is physical. While finding board certified surgeons who you trust and feel comfortable with is paramount to your medical care, reading about other people’s journeys and creating a strong support system before, during, and after surgery can help to alleviate some of the emotional burden. 

Patient Perspective

While it is important to know what to medically expect from a mastectomy, understanding the emotional toll of choosing to remove one or both breasts is equally vital. Here, two women share their deeply personal and resilient experiences.

How To Take Control Of Your Mastectomy Journey From Patients' Perspective

How To Take Control Of Your Mastectomy Journey

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and [roundups of products that give back](https://aedit.com/aedition/beauty-fashion-products-that-give-back-for-breast-cancer-awareness-month-2019).*

According to the [U.S. Department of Health and Human Services’ National Cancer Institute](https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#r1), 268,600 women will be diagnosed with breast cancer in 2019. There will also be an estimated 2,670 new cases of invasive breast cancer reported in men. When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role, but the surgery is deeply personal and emotional. Approaching the procedure and all the decisions that accompany it armed with the best information is key, and The AEDITION here to help.

## **What Is a Mastectomy?**
A mastectomy is a surgery to remove tissue from one or both breasts in an effort to eliminate cancer cells or prevent cancerous tumors from forming in the future. Not to be confused with a lumpectomy, which extracts lumps of cancerous cells from the breast without removing all of the surrounding tissue, a mastectomy involves the removal of all the breast tissue. While a lumpectomy is a less invasive breast cancer treatment option — both physically and emotionally — it is not always an aggressive enough solution. 

## **What Are the Types of Mastectomies?**
There are four main types of mastectomies that, whether the procedure is being used for breast cancer prevention or treatment, can be performed unilaterally (removing one breast) or bilaterally (removing both breasts). Which technique is chosen often depends on a patient’s body and diagnosis. 

- **Simple (a.k.a. Total) Mastectomy**: A surgeon removes the entire breast (including the skin, tissue, nipple, and areola) but does not perform a lymph node dissection.

- **Radical Mastectomy**: Reserved for rare cases when the cancer has spread into the underlying muscles, the procedure removes the breast, three levels of underarm lymph nodes, and the chest muscles under the breast. In a more common modified radical mastectomy, the breast tissue and lymph nodes are removed but the muscles of the chest wall remain.

- **Skin-Sparing Mastectomy**: For patients who wish to combine a mastectomy with breast reconstruction surgery, this technique seeks to preserve as much of the breast skin as possible — regardless of whether a simple or radical procedure was performed.  

- **Nipple-Sparing Mastectomy**: Surgeons remove the breast tissue but keep the skin, nipple, and areola to aid the reconstruction process.

## **Do Women Carrying the BRCA1 or BRCA2 Gene Need a Prophylactic (i.e. Preventative) Mastectomy?**

About 12 percent of women in the general population will develop breast cancer in their lifetime. Of women carrying BRCA1 or BRCA2 mutations, an estimated 72 and 69 percent will develop breast cancer by the age of 80, respectively. 

While the decision is a personal one, [National Cancer Institute data shows](https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet) that women with either gene who undergo a prophylactic (a.k.a. preventative) mastectomy reduce their risk of breast cancer by 95 percent. Women who have a strong family history of breast cancer, meanwhile, see their risk mitigated by up to 90 percent with the procedure.

## **Mastectomy FAQ**
Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), who specializes in reconstructive surgery following trauma and cancer, answers some of the most common questions that accompany mastectomy procedures.

**The AEDITION**: *Is a mastectomy a 100 percent guarantee to be breast cancer-free?*

**Dr. Unger**: No, there is always a chance of recurrence. No surgery can guarantee removal of every single cell of breast tissue. Recurrence rates are usually between one and five percent, depending on multiple factors for each individual person.

**The AEDITION**: *Can men get breast cancer and need a mastectomy?*

**Dr. Unger**: Yes, men can absolutely get a mastectomy. Depending on the size of the man’s breast, the scar pattern will vary, but the goal is to create a flat chest with aesthetically acceptable scar patterns that are hopefully hidden in the creases of the male pectoral muscles, if it all possible.

**The AEDITION**: *When would someone get a unilateral versus bilateral mastectomy?*

**Dr. Unger**: There are times where bilateral mastectomy is indicated from the cancer standpoint — such as if you have cancer in both breasts or have a particular type of cancer that leads to a very high risk of having cancer in the opposite breast as well as one that is primarily diagnosed.

I typically have a long conversation with patients talking about the pros and cons of unilateral versus a bilateral mastectomy. One of the common reasons for bilateral mastectomy is many women do not feel comfortable keeping one natural breast. In these cases, there is also the additional upside of being able to attain symmetry much more easily due to the fact that I, as the reconstructive surgeon, am able to create the same thing on both sides. This is more difficult to do with one natural breast and one reconstructed breast.

Young women with a higher lifetime risk or women with large and low ptotic breasts are often best suited for bilateral, from both the risk standpoint and to create better shape and more symmetric breasts.

**The AEDITION**: *How does a patient choose between a skin-sparing and nipple-sparing mastectomy?*

**Dr. Unger**: The data is fairly clear that, unless there is direct nipple involvement, it is equally safe to get a nipple-sparing mastectomy or skin-sparing mastectomy. The reasons to get a skin-sparing mastectomy and remove the nipple are, again, if there is direct involvement of the nipple with cancer thus being unable to keep it; or if the nipple is in a very poor position — such as too low — making it an impediment for creating an aesthetically pleasing outcome. Smaller breasts and even some larger, well-shaped breasts are often good candidates for nipple-sparing mastectomy.

## **What Is It Like to Get a Mastectomy?**
The mastectomy experience varies between patients since each person has a unique medical history and diagnosis. After finding the right surgeon(s) and determining the best course of action for your condition (some mastectomies may be combined with radiation or other treatments), the mastectomy procedure generally involves the same course of action.

Without breast reconstruction, a mastectomy is usually an outpatient procedure that lasts one to three hours and is performed under general anesthesia. The surgeon typically begins by making an elliptical incision around the breast (more incisions may be needed for a nipple-sparing surgery) and removing the tissue and any other part of the breast (i.e. the nipple, skin, areola) decided upon. The sentinel node or axillary lymph node dissection will also be performed as needed.

If a reconstructive procedure is not being performed in tandem, the surgeon will insert surgical drains to accommodate excess fluid and close the incision (the drains will be removed during the first post-op appointment, about one to two weeks after the procedure). The entire surgical site is then wrapped with a bandage. 

Mastectomy side effects are similar to those of most surgeries, and many doctors will prescribe pain medication to deal with the symptoms. Most patients experience pain and swelling, buildup of blood at the surgery site, limited mobility, and numbness. Infection is also possible, as is lymphedema (fluid build-up), in cases where the nodes are removed. 

Depending on the type of mastectomy performed, some patients may be able to go home the same day, while longer hospital stays (up to three days) may be needed for bilateral and reconstructive procedures. 

## **Post-Mastectomy FAQ**
So, what can patients expect in the aftermath of a mastectomy? The AEDITION spoke to [Leif Rogers, MD](https://aedit.com/provider/leif-rogers-md-578), a Beverly Hills-based board certified plastic and reconstructive surgeon who is a pioneer in advanced breast reconstruction, about what to expect post-op.  

**The AEDITION**: *What does the chest look like after a mastectomy?* 

**Dr. Rogers**: How a chest looks after a mastectomy is completely dependent on the oncological breast surgeon. Different surgeons have different preferred techniques. If a traditional mastectomy is performed without a skin-sparing technique, the chest has a transverse scar on it running from the axillary lymph nodes (armpit area) to almost the sternum. If skin-sparing is performed and a tissue expander or implant is placed at the time of mastectomy, the breast can look relatively normal immediately. Additional surgeries are often needed to fine-tune the result for symmetry and optimal cosmesis.

**The AEDITION**: *When it comes to breast reconstruction after a mastectomy, what can patients expect?*

**Dr. Rogers**: There are a great many things that can be done for breast reconstruction. Many of the old limitations for reconstruction — especially after radiation therapy — no longer apply. I can build a breast using an implant or a patient’s own tissue. If a patient elects to use her own tissue, there are many different procedures to choose from. I feel the best three, in terms of the cosmetic outcome of the breast and minimal donor site morbidity, are the DIEP flap (deep inferior epigastric perforator, which runs through the abdomen), the TUG flap (transverse upper gracilis in the upper thighs), and autologous fat grafting. All of these techniques can be used to create one or both breasts without the use of an implant. 

Implant reconstructions have also gotten much better with the addition of autologous fat grafting. Fat grafting can smooth out the contours and make almost any implant reconstruction look like a natural breast. Nipples can also be reconstructed using one of a number of techniques and can look 90 percent like the original. Nipple reconstruction has been less often required in recent times due to the acceptance of nipple-sparing mastectomies.

**The AEDITION**: *When do you recommend patients get reconstructive surgery?* 

**Dr. Rogers**: I always recommend starting the reconstructive process at the time of mastectomy. The cosmetic outcomes are far superior. I also recommend skin-sparing and, if possible, nipple-sparing mastectomies. I find that even if a flap procedure is the chosen method of reconstruction, the primary placement of a tissue expander improves the cosmetic outcome and decreases complication significantly.

## **The Takeaway**
While a mastectomy is never an easy procedure for the patient or their loved ones, much progress has been made in surgical and reconstruction methods. Finding the right surgeons and treatment for your diagnosis will ensure you get the best care possible, and, for those who choose to undergo a reconstructive procedure in tandem (or in the future), natural breasts are attainable through [implants](https://aedit.com/procedure/breast-augmentation-with-implants), [fat grafting](https://aedit.com/procedure/breast-augmentation-with-fat-transfer), or a combination of the two. 

When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role, but the surgery is often deeply personal and emotional. Here, The AEDITION speaks with two preeminent reconstructive surgeons about the procedure. 