What Are My Breast Reconstruction Options? And What to Expect

Figuring out which breast reconstruction option to go with — like going flat, getting implants, or simply doing nothing — can be a difficult decision to make.

If you’ve received a breast cancer diagnosis recently, it’s easy to feel overwhelmed with all the things to think about and decisions to make.

You’re most likely getting a mastectomy or lumpectomy and trying to figure out if and what other treatments you may need. Hello, scary chemo and radiation, do I really want to meet you?

You might be deeply contemplating your mortality and trying to contain fear, anxiety, and the unknown while coordinating logistical aspects of life. Who will feed the dog when I’m in the hospital and help my kindergartener with school things?

It’s a lot.

On top of all this, you may be trying to figure out what type of breast reconstruction feels right for you. This was me. I had a double mastectomy on January 2, 2015. What a way to kick off the new year!

I had two totally different breast reconstruction surgeries in the years after, and it was an emotional rollercoaster. I wasn’t well versed in the various types of surgeries available to me at the time.

But I know more now, and this basic reconstruction overview can help ease the way. Though you may not feel like it now, you have options.

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Option 1: Aesthetic flat closure (“going flat”)

Aesthetic flat closure is a surgery that can be done from the beginning as your first reconstruction option, or later if you decide to remove any implants and “go flat” later on for whatever reason.

This surgery removes any excess skin, tissue, and fat from where the breast was removed. What is left is closed neatly, tightened, and smooth so the chest area is flat. You can do bilateral or unilateral flat.

Why do people choose to go flat? It may help them avoid further surgeries, complications from prior breast reconstructions or radiation, or breast implant illness.

Flat advocacy group Flat Closure Now is a great resource to check out to learn more about aesthetic flat closure.

Option 2: Breast implants

Implants have been one of the most common reconstruction options for years. And it’s not a “boob job” at all!

Saline or silicone implants are implanted in the chest either under or over the pectoral muscle to recreate a breast mound. Implant reconstruction can happen at the time of the mastectomy. The other option is to get chest expanders put in during the mastectomy.

Think of chest expanders as empty balloons placed inside the chest either under or over the pectoral muscle. The balloons are filled with saline through a port over time. This slowly stretches the remaining skin and tissue to accommodate a future implant placement surgery.

Option 3: Autologous reconstruction

Auto what, you ask? This is a surgery performed by a plastic surgeon who specializes in microsurgery. Tissue is harvested from another part of your body and transferred to your chest to make a breast mound.

Here is a quick overview of some types of autologous surgeries available, which depend on your body type and other factors:

• DIEP (deep inferior epigastric perforator) flap: Excess soft tissue from the abdomen is relocated to the chest to form breast mounds.
• SGAP (superior gluteal artery perforator) flap: This uses tissue from the upper hip area.
• TUG (transverse upper gracilis) flap: This uses tissue from the upper inner thigh.
• TRAM (pedicle transverse rectus abdominal muscle) flap and free TRAM flap: Unlike the DIEP flap, this uses tissue from your abdominal muscles and some soft tissue as well.
• Latissimus dorsi flap: This uses tissue from the back.

There are several other specific types of flap procedures, all of which include tissue from the abdomen, back, buttocks, or thighs.

One of the reasons people choose autologous reconstruction is that it can be a more natural-looking and feeling breast mound. Also, some people would just rather not have implants inside their bodies or worry about replacing them in the future.

Option 4: Do nothing after mastectomy

What’s the difference between aesthetic flat closure and doing nothing? As previously explained, aesthetic flat closure is when everything is left clean and flat by removing excess tissue.

Doing nothing is a great option if you don’t know what you want to do after breast surgery. Some excess skin may be left behind to help accommodate for implants or form breast mounds with autologous surgery later.

It’s OK to do nothing now and not be pressured into any reconstruction right away. It’s OK to feel indecisive and take time to think. Needing a break from surgeries and treatment, and the timing with other things to consider in life, are just some of the common reasons to do nothing and delay reconstruction.

Tips for considering your options

Here are some things that will help when considering breast reconstruction options:

• Do some homework and research.
• Lean into online communities like Bezzy BC and ask people to share their experiences.
• Get a consultation with more than one surgeon that specializes in working with people with breast cancer and who wants to help you get the type of reconstruction you want.
• Don’t stop with your reconstruction until you’re satisfied. You deserve to feel and look your best, whatever that may be for you.
• Ask to see reconstruction pictures and outcomes from surgeons and people in the breast cancer community.
• Don’t settle! There are really great surgeons out there doing great implant, autologous, and aesthetic flat closure surgeries, and sometimes you just have to find them.

I first started off with implant reconstruction that I was very unsatisfied with, and ended up getting a second reconstruction — a DIEP flap recon I am happy with. I credit this to the beautiful people in the breast cancer community sharing both their reconstruction stories and chests with me so I knew I could get something better.

I hope to see you in the Bezzy BC app where I am your guide. We have both a breast reconstruction forum and an aesthetic flat closure forum, making it easy to connect with others on these topics.

Have thoughts or suggestions about this article? Email us at article-feedback@bezzy.com