Breast Reconstruction: Restoring Form and Confidence with Implant Reconstruction & Autologous Tissue
By Dr. Tim Neavin, MD | Board-Certified Plastic Surgeon Last updated: October 2025
Available at our offices:
Breast Reconstruction in Beverly Hills
Breast Reconstruction Overview: Why, When, and How
As a plastic surgeon specializing in breast reconstruction, I understand this journey represents far more than surgical technique—it’s about restoring wholeness after cancer treatment. Breast reconstruction after mastectomy or lumpectomy is a deeply personal decision that requires careful consideration of your cancer treatment plan, anatomy, and personal goals. My role is to work seamlessly with your oncology team, ensuring breast reconstruction planning aligns with your treatment pathway while never delaying critical cancer care.
I offer two primary approaches for breast reconstruction: implant reconstruction and autologous reconstruction using your own tissue via flap reconstruction. Many patients also benefit from symmetry procedures on the opposite breast to achieve optimal balance. The choice between breast reconstruction options depends on your anatomy, cancer treatment plan, lifestyle preferences, and personal goals. Each breast reconstruction approach offers distinct advantages, and I work closely with patients to determine which breast reconstruction path will best serve their individual needs.
Core Reconstruction Options at a Glance
- Implant reconstruction: This approach can be accomplished through direct-to-implant placement or a two-stage expander-to-implant process using either silicone or saline breast implants. This typically involves shorter surgery time and faster initial recovery compared to flap surgery.
- Autologous reconstruction: This involves transferring your own living tissue from areas like the abdomen, thigh, or back through procedures like DIEP flap, MS-TRAM flap, PAP flap, or latissimus flaps to create a more natural breast that ages with your body and often tolerates radiation therapy better than implants.
- Hybrid approaches: Sometimes I combine techniques, using a tissue flap with a small implant or incorporating fat grafting to achieve optimal shape refinement and the most natural results possible for the reconstructed breast.
Candidacy and Goal Setting with Your Plastic Surgeon
During our breast reconstruction consultation, I focus on understanding your medical history, lifestyle, and aesthetic preferences. Ideal candidates for breast reconstruction are medically optimized with realistic expectations who can clearly communicate their priorities regarding the feel, appearance, and behavior of their reconstructed breast. The breast reconstruction candidacy evaluation includes assessment of your cancer treatment timeline, skin quality, and tissue characteristics that will influence breast reconstruction options.
As your plastic surgeon, I conduct a thorough examination for breast reconstruction planning, measuring chest wall dimensions, assessing skin quality, and evaluating soft-tissue coverage. We review existing scars, radiation therapy plans, and your preferences between implant reconstruction and tissue reconstruction approaches. This comprehensive breast reconstruction evaluation helps determine which breast reconstruction option will provide the best outcomes for your specific situation.
Shared Decision-Making
Together, we establish realistic expectations about projection, upper-pole contour, and whether your breast reconstruction plan should prioritize minimal downtime or the most natural breast feel. Patients who are well-informed and actively involved in breast reconstruction decision-making tend to be most satisfied with their final breast reconstruction outcomes and long-term results.
Timing: Immediate vs Delayed Breast Reconstruction
The timing of breast reconstruction is critical and coordinated carefully with your breast surgeon and oncologist. Both immediate breast reconstruction and delayed breast reconstruction approaches have advantages depending on your cancer treatment plan and individual circumstances. The breast reconstruction timing decision impacts both the surgical approach and final breast reconstruction outcomes.
Immediate Reconstruction
Immediate breast reconstruction, performed during mastectomy, offers psychological benefits as you wake up with a breast mound in place. This breast reconstruction approach works well with skin-sparing mastectomy or nipple-sparing mastectomy techniques, preserving more natural breast envelope and skin for better aesthetic results. However, immediate breast reconstruction is not appropriate when post-operative radiation therapy is planned, as radiation can affect tissue healing and implant outcomes.
Delayed Reconstruction
Delayed breast reconstruction, performed months or years after mastectomy, is often safer when radiation therapy is planned or completed. This breast reconstruction timing allows complete tissue recovery from cancer treatment and careful consideration of breast reconstruction options without the pressure of making decisions during the emotional stress of cancer diagnosis and initial treatment.
Coordinating with the Breast Surgeon and Oncology Team
Seamless collaboration with your cancer care team is essential for successful breast reconstruction outcomes. Your breast surgeon focuses on cancer control and optimal mastectomy technique while I restore symmetry and comfort through breast reconstruction. We coordinate timing of lumpectomy or mastectomy, margin assessments, and adjuvant therapies with breast reconstruction options, ensuring breast reconstruction never delays critical cancer treatment. This multidisciplinary approach to breast reconstruction ensures both oncologic safety and optimal aesthetic outcomes.
Oncoplastic Collaboration
For lumpectomy patients, I often work directly with the breast surgeon during surgery to perform oncoplastic reshaping as part of breast reconstruction, maintaining breast contour while preserving surveillance access and achieving excellent cosmetic outcomes. This collaborative breast reconstruction approach can address cancer treatment needs while optimizing breast appearance.
Implant Reconstruction: Breast Implants for Direct-to-Implant and Expander Options
Implant reconstruction uses silicone or saline breast implants to rebuild breast volume and achieve natural breast contours. This breast reconstruction approach offers shorter surgery time and faster recovery compared to flap surgery. Key decisions in implant reconstruction include device profile, base width, and pocket placement—either above the muscle (prepectoral) or under the muscle (subpectoral). The choice of implant placement significantly impacts both the immediate results and long-term outcomes of breast reconstruction.
Direct-to-Implant (DTI)
Single-stage permanent implant placement at mastectomy represents an efficient breast reconstruction approach that works best in select candidates with favorable skin quality, good tissue perfusion, and no planned radiation therapy. During direct-to-implant breast reconstruction, I often use acellular dermal matrix (ADM) for additional support and to create natural breast shape and projection.
Tissue Expander to Implant
Two-stage implant reconstruction with gradual expansion over weeks or months, then permanent implant replacement in a second surgery. This breast reconstruction approach helps when skin needs time to adapt or after radiation therapy, allowing controlled stretching and size adjustments. The tissue expansion process in breast reconstruction allows for gradual skin accommodation and optimal final implant positioning.
Autologous Tissue: DIEP, MS-TRAM, PAP, and Latissimus Flap Reconstruction
Autologous tissue reconstruction transfers your own skin, fat, and sometimes muscle to create a new breast through flap surgery. This breast reconstruction approach creates a soft, warm, natural breast that ages with your body, tolerates radiation therapy better than implants, and doesn’t require replacement over time. Common flap surgery options for autologous breast reconstruction include abdominal tissue (DIEP flap, MS-TRAM flap), thigh tissue (PAP flap), and back tissue (latissimus flap). Autologous reconstruction represents the most natural form of breast reconstruction available.
Why Choose Autologous Reconstruction?
Many patients choose tissue reconstruction and flap surgery for the most natural result possible in breast reconstruction. The reconstructed breast from autologous tissue gains and loses weight with you, feels warm, and moves naturally. There’s no risk of implant complications with autologous reconstruction, and it’s excellent for patients who’ve received radiation therapy or prefer to avoid foreign devices in their body.
Prepectoral vs Subpectoral Planes in Implant Reconstruction
Implant placement location is a key decision in implant reconstruction that affects both immediate results and long-term outcomes. Prepectoral implant placement (above muscle) avoids animation deformity and is more comfortable for athletics, preserving natural chest muscle function. Subpectoral implant placement (under muscle) provides better soft tissue coverage and may be preferable with thin skin or limited tissue coverage after mastectomy.
Use of ADM (Acellular Dermal Matrix)
I frequently use ADM as an internal support system in breast reconstruction, helping create natural breast shape and potentially reducing capsular contracture risk. This biological mesh integrates with your tissue over time and significantly improves aesthetic results in both implant reconstruction and some flap reconstruction cases.
Choosing Breast Implants: Silicone, Saline, Profile, and Projection
Selecting the right breast implants for your breast reconstruction involves careful consideration of your anatomy and aesthetic goals. I match implant base width to chest wall dimensions and choose appropriate projection for your desired silhouette in breast reconstruction. Silicone gel implants offer more natural feel and less rippling, while saline implants allow surgical adjustment and require smaller incisions during breast reconstruction procedures.
Implant profile significantly impacts the final appearance in breast reconstruction—higher profiles provide more forward projection with smaller base width, while moderate profiles offer broader, more natural slopes. I consider your lifestyle, activity level, and personal preferences when making recommendations for your breast reconstruction.
Capsular Contracture & Revision Considerations
We discuss capsular contracture possibilities, massage protocols, and long-term implant care as part of your breast reconstruction education. I explain when revision, replacement, or removal might be appropriate in the future, ensuring you understand the long-term commitment of implant reconstruction and potential need for additional procedures.
DIEP Flap and MS-TRAM Flap: Autologous Reconstruction from the Abdomen
Abdominal tissue flaps are the gold standard for autologous reconstruction and represent the most common flap surgery choice in breast reconstruction. DIEP flap (Deep Inferior Epigastric Perforator) preserves all rectus abdominis muscle while transferring lower abdomen skin and fat for breast reconstruction. MS-TRAM flap (Muscle-Sparing TRAM) uses a small muscle segment for enhanced blood supply while preserving abdominal wall strength. Both flap reconstruction techniques create excellent outcomes in tissue reconstruction for breast reconstruction.
Both DIEP flap and TRAM flap create warm, soft, natural breast volume with an abdominoplasty-like benefit at the donor site. The choice between these flap surgery techniques depends on your vascular anatomy, assessed through pre-operative imaging studies that help determine the safest approach for your breast reconstruction.
TRAM Flap Pearls
Classic tram flap approaches remain valuable in revision breast reconstruction cases or when previous abdominal surgery has altered vascular anatomy, making this flap surgery option an important tool in complex breast reconstruction situations.
PAP and Latissimus Dorsi Flaps: Thigh and Back Tissue Reconstruction
For patients who aren’t candidates for abdominal flaps, I offer alternative donor sites. PAP (Profunda Artery Perforator) flap uses posterior thigh tissue and suits slender patients without adequate abdominal tissue. Latissimus dorsi flap from the back provides reliable, well-vascularized tissue, used alone or with implants in hybrid approaches.
Flap Selection Factors
I choose flaps based on anatomy, previous scars, BMI, activity level, and preferences, evaluating each donor site for the safest surgery and most aesthetic result.
Nipple and Areola: Immediate Preservation or Delayed Reconstruction
The nipple-areola complex is the focal point of reconstruction. When oncologically safe, nipple-sparing mastectomy preserves your natural complex with sensation and appearance. When preservation isn’t possible, I offer excellent reconstruction options using local tissue flaps, skin grafts, or 3D medical tattooing.
Delayed reconstruction typically occurs after the breast mound heals, allowing optimal positioning. The newest advancement is 3D nipple-areola tattooing, creating remarkably realistic results without additional surgery.
Restoring the Reconstructed Breast Focal Point
I customize position, projection, size, and color for symmetry and the most natural appearance possible.
Radiation Therapy and Its Impact on Reconstruction Options
Radiation therapy is crucial for many cancer patients but presents special considerations for breast reconstruction planning and outcomes. Radiation therapy can stiffen skin, reduce tissue elasticity, and increase implant complications including capsular contracture and implant malposition. For patients requiring radiation therapy, I often recommend autologous tissue reconstruction and flap surgery, as living tissue tolerates radiation therapy better than breast implants and provides more durable long-term results.
Sequencing Around Radiation
I coordinate closely with your radiation oncologist on timing tissue expansion, flap surgery, or implant placement to minimize complications and optimize both cancer treatment and breast reconstruction outcomes. This careful coordination ensures your breast reconstruction plan accommodates radiation therapy without compromising either cancer treatment or aesthetic results.
Sensation, Nerve Coaptation, and the Feel of a Natural Breast
Sensation restoration is important to many patients. With some autologous flaps, I can perform sensory nerve coaptation, connecting transferred tissue nerves to chest wall nerves. This microsurgical technique can help restore protective sensation gradually, though recovery varies significantly.
Expectations by Technique
Tissue flaps feel warm, soft, and move naturally, while implants provide excellent shape but feel firmer and cooler. Understanding these differences helps you choose the approach matching your priorities.
Symmetry Procedures for the Opposite Side
Achieving symmetry often requires procedures on the non-cancer breast—reduction, lift, or augmentation—to match the reconstructed breast. I plan these procedures to create optimal balance in clothing with and without a bra.
Staging and Insurance Considerations
Symmetry procedures are often staged separately for optimal healing. Insurance coverage is federally mandated, and my team helps navigate approvals.
Fat Grafting for Contour Refinement
Fat grafting refines reconstruction results by softening implant edges, improving rippling, or enhancing upper-pole fullness. I harvest fat from abdomen or flanks and strategically inject it for the most natural contour possible.
Source Sites and Sessions
Multiple sessions spaced months apart allow gradual improvement and optimal fat survival, with minimal downtime.
Risks, Complications, and Revision Pathways
As with any surgical procedure, breast reconstruction carries certain risks that I discuss thoroughly with every patient. For implant-based reconstruction, potential complications include capsular contracture, infection, implant malposition, rippling, or implant rupture. For autologous tissue reconstruction, risks include partial flap loss, fat necrosis, donor site complications, or healing issues.
While complications can occur, my extensive experience and careful surgical technique help minimize these risks. I also emphasize the importance of following all pre- and post-operative instructions, maintaining good overall health, and attending all follow-up appointments.
When complications do arise, early recognition and prompt treatment are key to achieving the best possible outcome. I provide detailed instructions about warning signs to watch for and ensure that patients have 24-hour access to reach me or my team with any concerns.
Monitoring and Follow-Up
Regular follow-up visits allow me to monitor your healing progress, address any concerns early, and plan any additional procedures that might enhance your results. I maintain long-term relationships with my breast reconstruction patients for ongoing surveillance.
Recovery Timeline and Return to Activity
Recovery varies by technique, but I provide detailed guidance for each phase. Direct-to-implant has shorter initial recovery, while flap surgery requires more time for both reconstruction and donor sites to heal. We progress from walking to normal activities with clear milestones.
Comfort and Scar Care
Support garments, gentle mobility, scar massage, and sun protection optimize healing and aesthetic outcomes.
Results, Longevity, and When to Consider Secondary Procedures
Reconstruction results improve over time as swelling resolves and tissues settle. Most patients see significant improvement over the first year. Implant reconstructions may require future revision due to normal aging or preference changes, while autologous tissue ages naturally and typically needs fewer major revisions.
Secondary procedures like fat grafting, implant exchange, or scar revision are common refinements that help achieve optimal aesthetic results.
Photographs and Realistic Benchmarks
I review before-and-after photos of similar cases during consultation to set realistic expectations and show the range of possible results.
Your Reconstruction Rights and Insurance Basics
Federal law typically covers breast reconstruction, symmetry procedures, and nipple-areola reconstruction, including complication treatment and external prostheses when appropriate. My team works with insurance companies for pre-authorizations and provides all required documentation.
Preauthorization & Documentation
Insurance approval requires detailed documentation including operative reports, photographs, and treatment plans. My team handles this efficiently to minimize delays.
Your Reconstruction Rights and Insurance Basics
Under federal law, insurance coverage typically includes breast reconstruction, symmetry procedures on the opposite breast, and nipple-areola reconstruction. This coverage extends to treating complications of reconstruction and providing external prostheses when appropriate.
My team works closely with insurance companies to obtain necessary pre-authorizations and provide all required documentation. We understand the insurance process and advocate for our patients to ensure they receive the coverage they’re entitled to under the law.
For patients with insurance coverage questions or those seeking alternatives to insurance-based care, we provide transparent pricing information and discuss financing options to make reconstruction accessible regardless of insurance status.
Preauthorization & Documentation
The insurance approval process requires detailed documentation including operative reports, photographs, and treatment plans. My team handles this process efficiently, working to minimize delays and ensure smooth approval for your reconstruction procedures.
Reconstruction Options Summary: Matching Technique to Lifestyle
| Path | Highlights | Considerations | Best Fit |
|---|---|---|---|
| Direct-to-Implant | Single stage; faster recovery | Requires good skin; radiation sensitive | Favorable mastectomy flaps, no radiation |
| Expander-to-Implant | Gradual shaping | Multiple visits; capsular risk | When skin needs time to adapt |
| DIEP / MS-TRAM Flap | Soft, warm, natural feel | Longer surgery; donor site recovery | Radiated tissue; implant-averse |
| PAP / Latissimus Flap | Options for slender or scarred abdomens | May pair with implant for volume | Limited abdominal tissue; prior surgeries |
Personalization Over One-Size-Fits-All
My approach to breast reconstruction planning is always individualized, adapting the breast reconstruction plan to your unique anatomy, cancer care requirements, lifestyle needs, and personal preferences. There’s no single “best” breast reconstruction technique—only the best technique for you at this point in your journey. Whether you’re considering breast reconstruction options immediately after mastectomy diagnosis or exploring delayed breast reconstruction options years later, I work to find the breast reconstruction approach that best serves your goals. Each patient’s breast reconstruction journey is unique, and I’m committed to helping you explore all breast reconstruction options to make the most informed decision about your care.
Frequently Asked Questions
Is Breast Reconstruction done at the same time as mastectomy?
Often, yes—immediate reconstruction can be performed at the same time as mastectomy when appropriate. However, when radiation therapy is planned or when the skin needs time to recover from cancer treatment, delayed reconstruction timing can actually be safer and provide better long-term results.
Which feels more natural—implants or autologous tissue?
Many patients describe tissue flaps as providing the most natural breast feel, as they’re warm, soft, and move naturally with your body. Implants can achieve excellent shape and appearance with shorter early recovery time, but feel firmer and cooler than natural breast tissue.
Can the nipple and areola be preserved?
When oncologically safe and appropriate based on tumor location and characteristics, nipple-sparing mastectomy can preserve your natural nipple and areola. When preservation isn’t safe or possible, I can reconstruct the nipple and areola with excellent aesthetic results using various surgical and non-surgical techniques.
What about exercise after reconstruction?
I encourage early walking and gradually increase activity levels based on your healing progress. Light activities can typically resume within a few weeks, while heavy lifting and intense exercise usually return after full clearance, particularly following flap surgery where donor site healing is also important.
Will I need more than one procedure?
Secondary refinement procedures are quite common in breast reconstruction and often planned from the beginning. These might include fat grafting for contour improvement, implant exchange for size or type changes, scar revision, or symmetry procedures on the opposite breast to achieve the best possible aesthetic result.
Flap Perfusion and Intraoperative Assessment
During flap reconstruction procedures, I use advanced perfusion monitoring techniques including fluorescent angiography to verify optimal blood supply to the transferred tissue. This technology helps reduce the risk of fat necrosis and ensures the healthiest possible flap survival.
Pocket Control in Subpectoral Implant Reconstruction
Creating the optimal implant pocket requires precise surgical technique including careful muscle release, strategic suturing, and often the use of ADM slings to support the lower pole and maintain a stable inframammary fold position. These technical details significantly impact both immediate and long-term aesthetic outcomes.
Donor-Site Planning and Scar Placement
When planning autologous reconstruction, I carefully map donor site scars to follow natural skin lines and hide within clothing boundaries whenever possible. Whether the scars are on the abdomen, thigh, or back, strategic placement can minimize their visibility and help patients feel confident in various clothing styles.
Dr. Tim Neavin is an outstanding plastic surgeon Professional with an uplifting bedside manner to make you feel comfortable post surgery; he sees the beauty in you and improves it with the right cosmetic technique. – Hugo
