If you’ve had a mastectomy, or are planning one, you might be wondering—what does breast reconstruction really involve? How do we begin to restore something so personal?
As a plastic surgeon, I often explain that reconstruction is not just about replacing what’s been lost. While every journey is unique, there are three core things we think about when rebuilding a breast after cancer: the foundation (or footprint), the volume and the skin envelope.
Let me walk you through what that means.
1. The Foundation: Understanding Your Chest Wall
Every reconstruction begins with a close assessment of the chest wall—the “footprint” of where your breast once sat. This includes the width, height and contour of the area. Like the foundations of a house, this base shapes everything built on top.
No two chest walls are the same. Some may be slightly sloped or asymmetrical—these are normal variations, not imperfections. But recognising these features helps us plan a reconstruction that is structurally sound, symmetrical, and appropriate to your natural form. A personalised foundation ensures that the reconstructed breast will complement your body and meet your expectations.
2. Volume: Replacing What’s Been Removed
Following a mastectomy, much of the breast gland and surrounding fat are removed. Replacing that lost volume is a central part of reconstruction.
This can be done using implants or your own tissue—typically taken from the abdomen, back, or thighs. Each approach has its benefits. Whether sculpted from your tissue or supported by an implant, the aim is the same: to restore volume that feels proportional, is appropriate to your form, and aligns with your expectations.
3. Skin Envelope: Resurfacing the Breast
The skin that covers the breast—the “jacket,” so to speak—also needs to be considered. If your mastectomy preserved the nipple and most of the breast skin (a nipple-sparing mastectomy), little adjustment may be needed. But if skin and nipple have been removed, reconstruction must account for this.
We may use local tissue flaps, skin grafts, or expanded skin to recreate a smooth, natural outer contour. This step helps complete the reconstruction and ensures the overall shape is both functional and visually appropriate to your body.
Bringing It All Together
Breast reconstruction is a personal journey, not just a surgical one. My goal is to help you move through this process with clarity, care, and confidence—so that the outcome not only looks right, but feels right to you.
By restoring the foundation, volume, and skin envelope in a way that is tailored to your form and expectations, we aim to achieve a reconstruction that reflects your sense of self—whole, strong, and truly yours.
If you’re considering reconstruction, I’m here to help you understand your options and support you through each step of the journey.