Breast Reconstruction

Breast reconstruction recreates a breast's shape and contour after a mastectomy or removal of a breast due to another disease or condition. It can also be used to augment or decrease the size of your breasts for either medical or cosmetic reasons.

In breast reconstruction, Cedars-Sinai's expert surgeons form a breast mound by using an implant or, through the use of microsurgery, tissues from the belly, back or buttocks. Implants are salt water or silicone gel filled silicone sacs. The type of reconstruction that best suits you depends on your body type, age and medical condition.

To achieve a natural-appearing breast, more than one surgery is usually necessary in breast reconstruction. Breast reconstruction may include adding a nipple and tattooing to define the areola, the dark area around the nipple. Also, if you choose, surgeons sometimes perform a procedure on the opposite breast to create a better, more natural appearing match.

The experts at the Center for Plastic and Reconstructive Surgery at Cedars-Sinai are expert in all forms of breast reconstruction, including:

Breast augmentation or augmentation mammoplasty is a surgical procedure that involves placing implants (sacks filled with silicone gel or saline) behind each breast to change the overall look, size and shape of a woman's breast for various reasons, including:
  • Restructuring the breasts following a mastectomy (removal of breasts due to cancer or other diseases)
  • Wanting bigger breasts due to aging or weight loss
  • Believing their breasts are too small
  • Correcting the reduction in breast volume after a pregnancy
  • Balancing differences in breast size

The Center for Plastic and Reconstructive Surgery offers a full range of surgical procedures for breast augmentation. Surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Breast augmentation surgery is reasonably straightforward. The overall placement and positioning of the implants depend on the patient's needs and the surgeon's technique. Incisions can be made under the breast fold, outer edge of the areola, armpit or in the umbilical area. Once the incision is made, surgeons will lift the breast tissue and skin to create a pocket under the chest muscle or directly behind the breast tissue. Implants are carefully centered beneath the nipple to give the breast its new shape. Surgeons make every effort to keep the resulting scars from the incisions as discreet as possible.

Breast lift (mastopexy) is a surgical procedure used to raise and reshape sagging breasts. Though the results of the surgery may last a long time, no procedure can withstand the effects of gravity so the procedure is not a permanent fix.

Many women consider a breast lift because nursing babies may have resulted in stretched skin and lower breast volume. Women are advised to delay the procedure until they are certain they will not have any more children because a pregnancy may cause the effects of the surgery to be lost.

The Center for Plastic and Reconstructive Surgery offers comprehensive surgical procedures for mastopexy. Experienced surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Breast lifts may be performed on an outpatient basis but if hospitalization is required, the stay is usually one or two days.

During the procedure, surgeons:

  • Administer anethesia. General anesthesia is administered for most procedures but if the incision is not too big, local anesthesia may be used
  • Outline the area from which breast skin will be removed
  • Remove excess skin
  • Insert a breast implant. If an implant is part of the surgical plan, it will be inserted under breast tissue or under the muscle of the chest wall
  • Reposition the nipple and areola for optimum appearance
  • Close the incision with stitches around the areola and the lower crease of the breast

Women with large, heavy breasts may experience physical discomfort and a variety of health problems caused by the excessive weight, which can have a negative impact on their well-being and quality of life.

Breast reduction (reduction mammaplasty) is a surgical procedure to reduce breast size. Surgeons remove excess fat, skin and glandular tissue from the breasts to give patients smaller breasts and physical, emotional and medical relief from the problems related to large breasts, including:

  • Back, neck and shoulder pain
  • Poor posture
  • Breathing problems
  • Skin rash under the breasts
  • Limited participation in physical activities
  • Feeling self-conscious
  • Low self-esteem
  • Difficulty fitting into certain clothing or bras

The Center for Plastic and Reconstructive Surgery offers comprehensive surgical procedures for breast reduction. Experienced surgeons use leading-edge technology and world-class surgical techniques.

Surgical Procedure

Breast reduction surgery usually takes two to three hours. The most common procedure involves surgical incisions around the outer edge of the areola and the natural curve of the crease under the breasts. The surgeons remove excess fat, tissue and skin, and move the nipple and areola into their new position to form the new shape of the breast.

Breast Reconstruction After Surgery

Breast reconstruction is a surgical procedure to rebuild a woman's breast contour after it has been surgically removed (partial or complete mastectomy) due to cancer or other diseases. The goal of breast reconstruction is to provide symmetry and a natural-appearing breast. Immediate reconstruction at the time of mastectomy is preferred, but each patient is treated on an individual basis in coordination with their general surgeon and oncologist. This procedure helps patients:

  • Keep their breasts balanced (size and symmetry)
  • Regain their self-confidence
  • Avoid using an external prosthesis

The Center for Plastic and Reconstructive Surgery offers comprehensive surgical procedures for breast reconstruction. Experienced surgeons use leading-edge technology and world-class surgical techniques.

Skin Expansion and Implant Insertion

A common technique used to reconstruct the breast involves expanding the skin underneath the breast removal site. Surgeons insert a balloon expander and a tiny valve mechanism beneath the skin and chest muscle. Through the tiny valve, salt-water solution is used to fill this balloon over a period of weeks or months to give the breast its new shape. After the breast has expanded to the appropriate size and shape, a permanent breast implant is inserted.

Tissue Flap Surgery

Another common technique to reconstruct the breast is called flap reconstruction. Once the proper implant is set in place, surgeons use tissue flap taken from the patient's back, tummy, hip or buttock to reconstruct the breast.

  • TRAM flap is a procedure that takes extra tissue skin and muscle from the lower abdominal wall to create a breast shape
  • A latissimus dorsi flap procedure removes muscle and skin from the patient's back when extra tissue is needed
  • A DIEP flap procedure takes fat and skin from the same area as the tram flap (excluding muscle) in order to form the breast mound
  • Gluteal free flap is a procedure that takes tissue from the gluteal of the buttocks to create the breast shape

After Surgery

Following surgery, patients are likely to feel tired, some pain and discomfort. Other complications may include bleeding, excessive scar tissue, fatigue and infection. Surgeons prescribe medication or use other methods to resolve these issues. Surgeons may also recommend additional surgical procedures to reconstruct the nipple and the areola.