Breast Reconstruction

Breast reconstruction is surgery that rebuilds the shape of a breast after breast tissue is removed during cancer treatment. At Sauk Prairie Healthcare in Prairie du Sac, WI, plastic surgeon Rosaline Reynolds, MD, MS, performs it at the Plastic and Cosmetic Surgery Clinic. For most patients, it follows a mastectomy, which removes the whole breast. It is also done after a lumpectomy, which takes out only part of the breast and can leave the two sides looking uneven. In both cases, the goal is the same, to rebuild a breast shape that fits your body.

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Because those choices are tied so closely to your cancer care, Dr. Reynolds plans reconstruction alongside your breast surgeon and oncology team rather than separately from them. Reconstruction is also rarely a single operation. It usually unfolds over several appointments across several months, which is why patients from Prairie du Sac, Sauk City, and the greater Madison area value having that care close to home, and personalized, individualized attention.

Who Breast Reconstruction Is For

Patients who have reconstruction are usually being treated for breast cancer, or are having a mastectomy to lower a high risk of it. When a mastectomy is planned, it helps to talk with a plastic surgeon before that surgery happens, even if you have not decided anything yet.

Reconstructive options are also available for women getting partial mastectomies, also called lumpectomies.

Importantly, breast reconstruction is typically covered by insurance. A federal law called the Women’s Health and Cancer Rights Act requires any plan that covers mastectomy to also cover reconstruction, symmetry surgery on the other breast, breast forms, and treatment of complications like lymphedema.

Those conversations are worth having long after the fact, too. Some patients were never offered reconstruction years ago, and others turned it down at the time and have since changed their minds.

Reconstruction is a choice, not a requirement. Some patients choose a flat closure, and some use a breast form that fits inside a bra. Those are real options, not lesser ones. A consultation helps you weigh what is available against what matters to you, not to talk you into surgery.

Reconstruction depends on healing, so general health matters. Smoking narrows the small blood vessels that feed healing skin and raises the risk of complications, which is why quitting before surgery and staying off it afterward makes a real difference. Diabetes and earlier chest surgery also affect which methods are safe. If an option carries more risk for you than for someone else, Dr. Reynolds will tell you before you decide.

Timing: Immediate or Delayed Reconstruction

Immediate reconstruction typically means that after your breast surgeon has removed the breast tissue, your plastic surgeon places a tissue expander underneath your breast skin, in one operation. Delayed reconstruction typically means that the tissue expander is placed 2 weeks after the mastectomy. (It can also be months or years later depending on individual patient circumstances.) Delaying reconstruction allows time for the breast skin to heal, and often leads to better outcomes with lower risks of infection and wound healing issues.

For most patients, delaying reconstruction until two weeks after mastectomy is usually advised, given the benefits. However, the final decision is a highly individualized and personalized one, and Dr. Reynolds will partner with you beginning at your consultation to determine the best plan for you.

Implant-Based Breast Reconstruction

Implant reconstruction is the most common approach in the United States, and Sauk Prairie Healthcare offers it. It usually takes two stages. In the first, a tissue expander is placed in the space where breast tissue used to be. An expander works something like a balloon under the skin. Over the following weeks, saline is added through a small port at office visits, usually every one to two weeks, until the skin has stretched enough to hold an implant.

The second stage is an outpatient surgery. The expander comes out, and a permanent silicone implant goes in. This exchange often happens three to six months after the first surgery when radiation is not part of the plan. Some patients can skip the expander and have the implant placed during the mastectomy. Skin quality, breast size, and the type of mastectomy decide whether that is realistic.

Implant surgery is shorter than using your own tissue, and recovery is faster. The tradeoff is upkeep. Implants aren't lifetime devices, so later surgery to replace or remove one is normal, not a sign something went wrong. Risks include infection, scar tissue tightening around the implant, shifts in position or symmetry, visible rippling, and changes in how the breast feels.

Flap Reconstruction and Other Ways to Restore Shape

Flap Reconstruction Using Your Own Tissue

Flap reconstruction builds the breast from your own skin and fat. The lower abdomen is the most common source. A Deep Inferior Epigastric Perforator (DIEP) flap moves skin and fat from the abdomen while leaving the muscle in place, which lowers the risk of abdominal weakness and hernia. When the abdomen is not a good donor site, surgeons can use tissue from the back, thigh, or buttock.

Flap surgery takes longer and includes a hospital stay so doctors can closely monitor blood flow to the moved tissue. It also leaves a second area to heal where the tissue came from. In exchange, the rebuilt breast is living tissue that softens and changes along with your body, and there is no implant to maintain. A flap requires enough tissue at the donor site and a longer recovery period, so it isn't realistic for every patient.

Oncoplastic Reduction After a Lumpectomy

A lumpectomy takes out the tumor and leaves the rest of the breast, but it can still leave a dent or a clear difference in size. That is more likely when the tumor is large compared with the breast. Oncoplastic reduction borrows breast reduction techniques to reshape the remaining tissue, typically about two weeks after lumpectomy, prior to radiation, so the breast keeps a natural contour. A matching reduction on the other breast is often done to keep the two sides even. This is planned with your breast surgeon, since removing the tumor comes first and the reshaping is built around it.

Fat Grafting and Contour Refinement

Not everyone who wants a smoother chest wants a rebuilt breast. Fat grafting moves fat from another area of your body, using liposuction, and injects it where the contour is uneven. It can soften irregularities after a mastectomy or lumpectomy, or fill small hollows in a finished reconstruction. It is also used along with mastectomy flap revision for patients who want a flat, even chest and no breast mound. These are smaller outpatient procedures, and you may need more than one session because the body reabsorbs some of the transferred fat.

Recovery and the Stages That Follow

Expect to feel tired and sore for several weeks after the first surgery. Drains are often in place for a short time. Your surgeon will limit lifting, overhead reaching, and exercise until you're cleared, and those limits matter most when you start feeling well enough to ignore them.

If you have an expander, the fill visits happen during this stretch, and each one takes only a few minutes. Some patients notice chest tightness or pressure for a day or two afterward. Recovery from the exchange surgery is usually easier than the first operation, since the skin has already been stretched.

The later steps are about refinement. A nipple can be rebuilt by folding nearby skin into shape and then tattooing it, or created with three-dimensional tattooing alone, which looks realistic without another surgery. Revision procedures improve symmetry and smooth out remaining differences. Scars fade and soften over the first year, and the breast keeps settling for months after the last procedure, so what you see early is not what you end up with.

Your Care Team at Sauk Prairie Healthcare

Breast reconstruction at Sauk Prairie Healthcare is performed by Rosaline Reynolds, MD, MS. She earned her medical degree and a master of science degree in translational research at the University of Pennsylvania Perelman School of Medicine. She then completed an integrated plastic surgery residency at the University of Wisconsin Hospital & Clinics in Madison. Her areas of interest include cosmetic and reconstructive breast surgery, body contouring, and skin cancer reconstruction. She sees patients with Alissa DeVos, MPAS, PA-C, at the Plastic and Cosmetic Surgery Clinic in Prairie du Sac.

Wait times are minimal, and the clinic accepts most major insurance plans. Coverage for reconstruction after a mastectomy, as well as balancing procedures after lumpectomy, is also protected by federal law, and clinic staff go over the details of your own plan with you before surgery is scheduled.

These decisions often come when you are already carrying a lot, and they rarely get settled in one sitting. What helps most is seeing your own situation clearly rather than reading general information, and that is what an appointment is for.

Sauk Prairie Healthcare prides itself in making patients feel well taken care of, not just like another number in a system. That is why we have an excellent dedicated breast nurse navigator, who is devoted to helping every breast cancer patient navigate the difficult journey.

Schedule a Breast Reconstruction Consultation

To talk through your options, call the Plastic and Cosmetic Surgery Clinic at Sauk Prairie Healthcare at 608-643-4140 and ask for a consultation with Dr. Reynolds. The visit includes an exam and a review of your treatment plan, so you leave knowing which methods are realistic for you and roughly how long they would take. No referral is needed. The clinic is at 250 26th Street, Suite 135, in Prairie du Sac, WI.

Frequently Asked Questions About Breast Reconstruction