Medically reviewed by David Bogue, MD, board-certified plastic surgeon | Last reviewed August 2026
Breast reconstruction is usually a process rather than a single operation. The plan depends on the breast surgery being performed, how much tissue and skin are removed, the need for radiation, and the breast size and shape being restored. Reconstruction may be performed at the time of mastectomy or later, and occasionally after lumpectomy when surgery leaves a significant defect. Revision procedures are common and may improve symmetry, breast shape, implant position, scars, or changes that develop over time.
Dr. Bogue works closely with the breast surgeon before surgery so the cancer operation and reconstruction can be planned together. He primarily performs implant-based breast reconstruction and prefers prepectoral reconstruction, with the implant placed above the chest muscle, when appropriate. He also tries to perform direct-to-implant reconstruction whenever feasible. When a staged approach is more appropriate, a tissue expander is placed and later exchanged for a permanent implant.
Dr. Bogue has extensive experience with both primary and revision breast reconstruction, including more complex problems involving implants, radiation, and breast asymmetry. His published work includes research on tissue-expander reconstruction and reconstruction of the irradiated breast, as well as a book chapter on nipple-areola reconstruction.
"Met Dr. Bogue during my recent breast cancer journey. Never expected to need a double mastectomy at 38 years old. From the first consultation he made me feel comfortable, answered all my questions and worked with my oncologist surgeon to get all the details worked out to do an immediate breast reconstruction during the mastectomy. You would never know I had a mastectomy now that I am healed up, he did a great job with a natural look. Dr. Bogue and his staff were excellent to me in such a stressful time."
Jennifer Goggin
Google Review
Breast Reconstruction FAQs
Can Breast Reconstruction Be Performed at the Same Time as a Mastectomy?
Yes. When reconstruction is performed during the same operation as the mastectomy, it is called immediate breast reconstruction. Dr. Bogue works closely with the breast surgeon before surgery to plan the operation and also coordinates in the operating room during the mastectomy and reconstruction.
Delayed breast reconstruction means the mastectomy and reconstruction are separated by a period of time. This may be recommended when there is concern about first confirming that the cancer has been completely removed before beginning reconstruction.
When immediate reconstruction is appropriate, Dr. Bogue prefers direct-to-implant reconstruction whenever feasible. In other cases, a tissue expander is placed first and later exchanged for a permanent implant.
What Is Direct-to-Implant Reconstruction?
Direct-to-implant reconstruction means the permanent breast implant is placed at the same operation as the mastectomy, without first using a tissue expander.
Dr. Bogue prefers this approach particularly with nipple-sparing mastectomy when the desired breast size is similar to the pre-mastectomy breast, the nipple-areola complex is in a good position, and the mastectomy skin has a strong blood supply.
During surgery, Dr. Bogue uses the SPY intraoperative angiography system to evaluate blood flow to the mastectomy skin flaps. If the blood supply is not adequate, he may instead place a tissue expander and allow the tissues to heal before proceeding with a permanent implant.
What Is Acellular Dermal Matrix, and Why Is It Used in Breast Reconstruction?
Acellular dermal matrix (ADM) is a collagen mesh derived from donated human skin that has been processed to remove the donor cells. It serves several important roles in implant-based breast reconstruction.
ADM provides internal support for the implant, adds an additional layer of coverage over the implant, and has been associated with a lower risk of capsular contracture. It is particularly useful in prepectoral reconstruction, where the implant is placed above the chest muscle rather than underneath it.
Dr. Bogue uses ADM to help support and stabilize the implant while creating the desired breast shape.
What Is Prepectoral Breast Reconstruction?
In prepectoral breast reconstruction, the implant is placed on top of the chest muscle rather than underneath it. Dr. Bogue prefers this approach when the mastectomy skin and soft tissues provide adequate coverage and blood supply.
Keeping the implant above the muscle preserves the normal position and function of the pectoralis muscle. It also generally causes significantly less postoperative pain, which can make recovery easier.
Another major advantage is that prepectoral reconstruction avoids animation deformity—the visible movement or distortion of the implant and mastectomy skin that can occur when an implant is placed beneath the chest muscle and the muscle contracts.
Acellular dermal matrix is commonly used to provide additional coverage and support around the implant. Whether prepectoral reconstruction is appropriate depends on the quality and thickness of the remaining breast tissues and the blood supply to the mastectomy skin.
When Is a Tissue Expander Needed?
A tissue expander is used when it is better to stage the reconstruction rather than place the permanent implant at the time of mastectomy.
Dr. Bogue typically chooses a tissue expander when:
- the desired breast size is much larger or smaller than the pre-mastectomy breast
- you are not yet sure what breast size you want
- post-mastectomy radiation is expected
- the SPY system shows inadequate blood supply to the mastectomy skin
- a significant amount of mastectomy skin must be removed, making direct-to-implant reconstruction too tight
A tissue expander is a temporary device that creates space for the final breast implant. It may be placed above or below the chest muscle and is gradually filled with saline during simple office visits. Saline can also be removed if the expander needs to be partially deflated.
Once the desired breast size has been reached and the tissues are ready, the expander is exchanged for a permanent implant. This second operation also gives Dr. Bogue an opportunity to refine the implant position and breast shape and, when helpful, add fat grafting to improve the contour and appearance of the reconstructed breast.
How Does Radiation Affect Breast Reconstruction?
Radiation causes permanent changes to the skin and soft tissues, making them less elastic and less predictable during healing. It can increase the risk of wound-healing problems, capsular contracture, implant exposure, and changes in breast shape. Importantly, the effects of radiation are lifelong, so complications can occur years after the reconstruction has been completed.
When significant radiation is involved, reconstruction using a patient’s own tissue—such as a DIEP flap—is often preferred because it replaces damaged, radiated tissue with healthy, non-radiated tissue. However, not every patient is a candidate for these more extensive procedures, and some women choose not to undergo them. Dr. Bogue does not perform DIEP or other microsurgical free-flap reconstruction, but he can discuss when referral for this type of reconstruction should be considered.
For patients who undergo implant-based reconstruction, Dr. Bogue generally uses a tissue expander when post-mastectomy radiation is expected and completes the implant reconstruction after radiation treatment.
In selected patients who later develop significant problems in radiated tissues, Dr. Bogue may use a latissimus dorsi flap as a salvage procedure. This brings healthy, non-radiated skin and tissue from the back to the breast while still using an implant for breast volume. Because an implant remains part of the reconstruction, the breast can often maintain an appearance similar to a standard implant-based reconstruction.
"Dr. Bogue performed my breast reconstruction after bilateral mastectomy, and I am so grateful for him and his team. Everything was thoroughly explained before the procedure, and he and his staff were always attentive, punctual, and professional. The implant reconstruction was executed beautifully, leaving a natural and symmetrical appearance with virtually no visible scarring. Regular follow up appointments ensured that everything healed well, which was comforting after a traumatic time.”
J.P.
Google Review
Will I Need Revision Surgery After Breast Reconstruction?
Often, yes. Breast reconstruction is usually a process rather than a single operation, and revision procedures are common even after a successful initial reconstruction.
Revision surgery may be used to improve breast symmetry, implant position, contour irregularities, scars, or areas where the soft-tissue coverage could be improved. Fat grafting can also be used to soften contour defects and improve the transition between the reconstructed breast and surrounding tissues.
The extent of revision varies considerably. Some patients need only a relatively minor procedure, while others require more substantial correction because of changes in the implant, capsule, breast tissues, or the effects of radiation over time.
What About My Other Breast For Symmetry?
When reconstruction involves only one breast, surgery on the opposite breast may help create better balance. Depending on your anatomy and goals, this may include a breast lift, breast reduction, or breast augmentation to improve the size, shape, and nipple position of the two breasts.
Importantly, these procedures are generally considered part of breast reconstruction rather than cosmetic surgery when they are performed to create symmetry after a mastectomy. The Women’s Health and Cancer Rights Act of 1998 (WHCRA) requires applicable health plans that cover mastectomy to also provide coverage for surgery and reconstruction of the other breast to produce a symmetrical appearance.
Coverage is still subject to the terms of your individual insurance plan, including applicable deductibles and coinsurance.
How Long is Recovery After Breast Reconstruction?
Recovery depends on the type of reconstruction, but many women spend one night in the hospital after mastectomy and reconstruction, while an increasing number are able to go home the same day.
Dr. Bogue uses Exparel, a long-acting local pain medication injected into the chest during surgery, to help reduce discomfort for several days. Combined with prepectoral reconstruction, this has made same-day discharge and a quicker early recovery possible for many patients. In general, patients undergoing prepectoral and direct-to-implant reconstruction tend to recover more quickly than patients having more extensive reconstructive procedures.
During the first two weeks, activity is kept light and drains are removed as output decreases. If a tissue expander is used, patients typically return to the office weekly during the expansion process. Additional treatments, including hyperbaric oxygen therapy, may occasionally be needed when there are concerns about healing or blood supply to the mastectomy skin.
Most patients gradually increase activity after the first couple of weeks, with heavier exercise and lifting generally delayed until about 6 to 8 weeks. Revision procedures are usually outpatient operations and generally involve less recovery than the initial mastectomy reconstruction.
Is Breast Reconstruction Covered by Insurance?
Yes. Breast reconstruction after mastectomy is generally covered by health insurance as part of breast cancer treatment. Coverage can include the initial reconstruction, later revision procedures, and surgery on the opposite breast when needed to improve symmetry.
Under the Women’s Health and Cancer Rights Act of 1998 (WHCRA), applicable health plans that cover mastectomy must also provide coverage for breast reconstruction and procedures on the opposite breast to create a symmetrical appearance.
Your deductible, coinsurance, network status, and other out-of-pocket costs still depend on your individual insurance plan. Dr. Bogue’s office can help review your benefits and obtain authorization when required. Learn more about the insurance plans Dr. Bogue participates with and available financing and payment options.
Breast Reconstruction Before & After
Ready to Discuss Breast Reconstruction?
Breast reconstruction involves important decisions about timing, technique, breast shape, and long-term treatment. Dr. Bogue can work with you and your breast surgeon to develop a reconstruction plan that fits your cancer treatment and your goals.