Procedural Steps

What happens during breast reconstruction surgery?

Step 1 – Anesthesia

In order to assure patient comfort during the breast reconstruction procedure, the proper medications will always be given. Our patients will undergo general anesthesia. Dr. Spindel will always recommend the best choice for his patients.

Step 2 – Flap techniques reposition a woman’s own muscle, fat and skin to create or cover the breast mound.

Sometimes a mastectomy or radiation therapy will leave insufficient tissue on the chest wall to cover and support a breast implant. The use of a breast implant for reconstruction almost always requires either a flap technique or tissue expansion.

A TRAM flap uses donor muscle, fat and skin from a woman’s abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Alternatively, your surgeon may choose the DIEP or SGAP flap techniques which do not use muscle but transport tissue to the chest from the abdomen or buttock.



A latissimus dorsi flap uses muscle, fat, and skin from the back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.



Occasionally, the flap can reconstruct a complete breast mound, but often provides the muscle and tissue necessary to cover and support a breast implant.



Step 3 – Tissue expansion stretches healthy skin to provide coverage for a breast implant.

Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. Tissue expanders will require a number of office visits over 4-6 months after placement of the expander to slowly fill the device through an internal valve to expand the skin leaving enough room for the implant.

A second surgical procedure will be needed to replace the expander if it is not designed to serve as a permanent implant.


Step 4 – Surgical placement of a breast implant creates a breast mound.

A breast implant can be an addition or alternative to flap techniques. Saline and silicone implants are available for reconstruction. Dr. Spindel will help you decide what is best for you. Reconstruction with an implant usually requires tissue expanders.

Step 5 – Grafting and other specialized techniques create a nipple and areola.

Breast reconstruction is completed through a variety of techniques that reconstruct the nipple and areola, leaving the breast looking more natural. Patients will have the option to have a nipple reconstructed or to leave breasts without a nipple.

Step 6 – Results and Recovery

Dr. Spindel and staff will explain what should be expected after the procedure is completed. Breast reconstruction results will be immediately visible. Recovery time is different for each individual. Pain, swelling, and scarring will improve with time. This procedure will leave patients with a natural looking appearance and help improve confidence and self-esteem that was lost.