After mastectomy, if you decide to pursue reconstruction, your breasts can be surgically recreated using implants, your own tissue or a combination of both. In either case, the implants or tissue replaces breast tissue removed during mastectomy.

Most plastic surgeons prefer to place breast implants beneath the chest muscle. This usually involves stretching the skin and muscle enough to create a pocket beneath the muscle to accomodate the implant. To do this, the surgeon uses a temporary implant called a tissue expander. It is gradually inflated over time and then, when the pocket is large enough, the expander is replaced with a full-sized implant.

If you have natural tissue reconstruction, skin and fat (and sometimes muscle) will be moved from somewhere else on your body to your chest. It will be placed over your muscle and under your breast skin (just like the breast tissue removed during mastectomy) and shaped into a breast.

Both implant and natural tissue reconstruction can be accomplished in several different ways. More surgeons are experienced with the traditional methods; fewer are experienced with newer, more sophisticated methods (although what some consider "new" have actually been around for years).

Traditionally, reconstruction is performed in three distinct stages:

1. First an initial breast mound (a breast without a nipple) is formed, with expanders or your own tissue.

2. A later operation adds the nipple, and makes any cosmetic revisions necessary to the new breast.

3. In a third, optional procedure, the nipple and areola are tattooed.

While most plastic surgeons still follow these same steps, others use newer techniques that shorten the overall reconstruction timeline. Some surgeons now use a non-expansive implant technique (see link below) that doesn't require expansion, for example.

And more frequently, women are candidates for nipple-sparing mastectomies. While their breast tissue is removed during mastectomy, the entire breast skin and nipple are retained.