Breast Reconstruction Reconstruction of the breast can often be accomplished following mastectomy for breast cancer. Breast reconstruction often restores a woman’s sense of well being and wholeness after the trauma of a diagnosis of breast cancer. There are several different ways to reconstruct a breast. The procedure is selected based of the patients overall health, the size and shape of the opposite breast, whether or not the patient has had irradiation, and the patients anatomy. Often more than one procedure is appropriate and the decision comes down to the patient’s preference. Reconstruction of the breast with a breast implant usually involves several staged procedures. The first step is to place a tissue expander under the chest skin and muscle and over several weeks, inflate the expander thus stretching the tissue enough to accommodate an implant. After expansion is complete, the expander is removed and a permanent implant placed. Nipple reconstruction is usually done as a third procedure. These procedures are usually done as outpatient surgery. The expander placement can sometimes be done at the time of mastectomy. Past or planned postoperative irradiation usually makes this reconstructive procedure less desireable. A TRAM flap is a procedure to reconstruct the breast using excess skin and fat from the lower abdomen. This is a major procedure that usually takes between 6 and 8 hours and requires several days in the hospital. The advantage of this procedure is that a breast mound can be constructed with one operation and usually no implant is required. Nipple reconstruction is usually done a few months after the TRAM flap after swelling has subsided. A Lattismus Dorsi flap uses skin and muscle from the back to provide healthy tissue to the chest. This is usually done in conjuction with an implant. This can be a useful procedure in the patient who has radiation damage to the chest. Other, more exotic procedures are sometimes recommended if patients are not suited for the above operations. These include using buttock or thigh skin and fat and using the operating microscope to attach blood vessles from the donor site to the chest. These procedures are usually done at academic centers such as Harborview or the University of Washington. Often, the opposite breast benefits from either a lift or reduction to help achieve better symmetery with the reconstructed breast. This is usually done after the initial reconstruction but is occasionally done at the same time. Insurance covers breast reconstruction and surgery on the opposite breast to help improve symmetry.