Breast reconstruction with implants is a specialized and transformative surgical path for women who have undergone a mastectomy, the surgical removal of a breast to treat or prevent cancer. The primary goal of this procedure is not just to recreate the physical form of a breast, but to restore a woman's sense of self, wholeness, and body confidence after a challenging cancer journey. This is achieved by using a breast implant, a medical device filled with either silicone gel or saline, to create a new breast mound that can closely match the shape, size, and appearance of the natural breast.

It is a profoundly personal choice and is considered an integral part of a patient's comprehensive cancer care and recovery. The process of implant-based reconstruction is a highly personalized journey, most commonly performed in two main stages, although single-stage options exist for certain candidates. The first stage often involves placing a temporary device called a tissue expander at the time of the mastectomy, which gradually prepares the skin and muscle for the final implant.

The second stage involves replacing the expander with a permanent breast implant to create the final, soft, and natural-looking breast shape. At Fortis Healthcare, our multidisciplinary team of breast surgeons, oncologists, and plastic and reconstructive surgeons work in close collaboration to provide compassionate, state-of-the-art care, guiding each patient through every step of this restorative process.

What is Implant-Based Breast Reconstruction?

Implant-based reconstruction is the most common method of breast reconstruction worldwide. It relies on a medical device, a breast implant, to provide the volume and shape of the new breast. The process is a testament to the synergy between oncologic safety and aesthetic restoration.

The Two-Stage Reconstruction Approach

This is the most common and versatile technique, offering excellent and reliable results.

Stage 1: Tissue Expander Placement

This initial stage is often performed at the same time as the mastectomy, a procedure known as immediate reconstruction.

• What is a Tissue Expander? A tissue expander is an empty, balloon-like silicone shell that has a small, built-in port.
   
• The Procedure: After the breast surgeon has removed the breast tissue during the mastectomy, the plastic surgeon places the deflated tissue expander in a carefully created pocket, usually beneath the pectoralis chest muscle. In many cases, a supportive biological mesh, called an Acellular Dermal Matrix ADM, is used to create a sling or "internal bra" to hold the bottom of the expander in the correct position and create a more natural breast shape.
   
• The Expansion Process: A few weeks after surgery, once you have healed, you will begin weekly or bi-weekly visits to your plastic surgeon's clinic. During these visits, a small amount of sterile saline solution is injected through your skin into the port of the expander using a fine needle. This process is gradual, slowly and comfortably stretching the overlying skin and muscle over several months to create a pocket of the desired size and shape for the final implant.

Stage 2: The Exchange Surgery

This is the second, and typically final, major surgical step, usually performed three to six months after the expansion process is complete.

• The Procedure: This is a shorter, less invasive outpatient surgery. The plastic surgeon makes an incision along your mastectomy scar, removes the tissue expander, and places the permanent, chosen breast implant into the well-healed pocket. The surgeon may also perform procedures at this time to adjust the shape of the pocket or to perform a symmetry procedure on the opposite breast such as a lift or reduction to achieve the best possible match.

Direct-to-Implant DTI Reconstruction

This is a single-stage procedure where the permanent breast implant is placed at the same time as the mastectomy, eliminating the need for a tissue expander and a second surgery. DTI reconstruction is an excellent option for a select group of candidates, typically women with smaller to moderately sized breasts, good quality skin, and who are able to have a nipple-sparing mastectomy.

When is Breast Reconstruction Recommended? Candidacy and Timing

Breast reconstruction is an option for nearly every woman who has had or will have a mastectomy. The decision is a deeply personal one.

Who is a Good Candidate?

You may be a good candidate for implant-based reconstruction if:

• You have been diagnosed with breast cancer and require a mastectomy.
• You carry a high-risk genetic mutation like BRCA and are considering a risk-reducing prophylactic mastectomy.
• You are in good overall health and can safely undergo surgery.
• You are a non-smoker, as smoking severely compromises healing.
• You have realistic expectations about the outcomes. A reconstructed breast will not have the same sensation as a natural breast and will have scars.
• You have enough healthy skin and muscle on your chest wall to support an implant.

The Timing of Reconstruction

• Immediate Reconstruction: The reconstructive process begins at the same time as the mastectomy. This has the significant psychological benefit of allowing a woman to wake up from surgery with a breast mound already in place, avoiding the experience of seeing a flat chest.
   
• Delayed Reconstruction: A woman may choose to have her reconstruction months or even years after her mastectomy and cancer treatments are complete. This allows her to focus solely on her cancer recovery first and make the decision about reconstruction without pressure.

Key Decisions in Implant-Based Reconstruction

Implant Type

• Silicone Gel Implants: These are the most commonly used implants in reconstruction as their soft, cohesive gel most closely mimics the feel and movement of natural breast tissue.
• Saline Implants: These can also be used and offer a different feel, and their deflation is immediately apparent if a rupture occurs.

Implant Shape and Size

The goal of reconstruction is to achieve symmetry with the remaining natural breast or, in the case of a double mastectomy, to create a result that is proportionate and natural for your body frame. Your surgeon will take meticulous measurements and help you select the implant volume, profile, and shape round or anatomical that will create the best possible match.

Nipple and Areola Reconstruction

This is the final, finishing touch of the reconstructive process, typically performed as a minor outpatient procedure several months after the final implant is placed and has settled.

• Nipple Reconstruction: The surgeon can create a new nipple mound using your own skin from the reconstructed breast in a procedure involving small skin flaps.
• Areola Reconstruction: The most common method for creating a natural-looking areola is through specialized 3D micropigmentation, or medical tattooing. A skilled tattoo artist uses different pigments to create a remarkably realistic illusion of a natural areola with color and projection.

Our Specialists

Breast reconstruction is a highly complex subspecialty that exists at the intersection of surgical oncology and plastic surgery. It requires a surgeon with a high degree of technical skill, a deep understanding of aesthetics, and a compassionate approach to cancer care.

Dr. Richie Gupta

SENIOR DIRECTOR & HOD PLASTIC SURGERY | Fortis Shalimar Bagh

Dr. Vipul Nanda

DIRECTOR PLASTIC SURGERY | Fortis Gurgaon

Dr. Manish Nanda

ADDITIONAL DIRECTOR PLASTIC SURGERY | Fortis Faridabad

Patient Stories

"Waking up from my mastectomy and feeling a breast mound already there was a huge emotional relief. It sounds like a small thing, but it made a massive difference in how I started my recovery journey. The process of tissue expansion over the next few months was gradual and manageable. The second surgery to exchange the expander for the permanent implant felt like the true final step in putting my cancer behind me. The reconstruction didn't just rebuild my breast; it helped rebuild my sense of self." - Shreya Varma, 48, Delhi

"I had my mastectomy ten years ago and chose not to have reconstruction at the time. Over the years, I grew tired of dealing with prosthetics. I finally decided to explore delayed reconstruction. The plastic surgery team at Fortis was incredible. They explained how they could still use a tissue expander to create a pocket for an implant even after all that time. The process took about a year from start to finish, including the nipple tattoo, but it has been so worth it. I feel whole again in a way I hadn't realized I was missing." - Priya Krishnan, 55, Gurugram

The Reconstructive Journey: A Detailed Walkthrough

The Consultation

Your journey will begin with a comprehensive consultation with a plastic surgeon, ideally before your mastectomy. The surgeon will evaluate your health, your cancer treatment plan, and your anatomy. They will discuss all your reconstructive options, including implant-based versus using your own tissue flap reconstruction. They will show you before-and-after photos and help you set realistic expectations for the outcome.

Stage 1: The Mastectomy and Tissue Expander Placement

• The Procedure: This is a major surgery performed under general anesthesia. The breast surgeon will perform the mastectomy. Then, the plastic surgeon will perform the first stage of reconstruction. A pocket is created under the chest muscle, the tissue expander is inserted, and often an ADM sling is placed. Surgical drains are placed to remove excess fluid.
• Hospital Stay: You will typically stay in the hospital for a few days for pain management and monitoring.
• Recovery: Recovery from this initial surgery takes about four to six weeks. You will have significant restrictions on your activity, especially lifting and reaching with your arms.

Stage 2: The Exchange Surgery

• The Procedure: This is a much shorter surgery, usually performed on an outpatient basis under general anesthesia. The surgeon will make an incision in the old mastectomy scar, remove the expander, and insert the permanent implant.
• Recovery: Recovery from the exchange surgery is much faster. Discomfort is generally mild and managed with oral pain medication. You will need to avoid strenuous activity for a few weeks, but most people return to work and light activities within a week or two.

Myths vs Facts

Take the Next Step

The decision to undergo breast reconstruction is a deeply personal part of the healing process after a breast cancer diagnosis. It is a choice that is fundamentally about restoring your sense of self and well-being. Implant-based reconstruction is a safe, reliable, and highly effective method to recreate the breast form and help you feel more confident and whole again.

If you are beginning your breast cancer journey or are considering delayed reconstruction, a consultation with an experienced and compassionate plastic surgeon is the best way to explore your options and understand what this restorative procedure can achieve for you.

CTA: Book a Plastic & Reconstructive Surgery Consultation / Get a Second Opinion

Frequently Asked Questions

Q1. How long does the entire breast reconstruction process take?

Ans. The full journey for a two-stage implant reconstruction, from the initial mastectomy and expander placement to the final nipple reconstruction, typically takes about six months to a year.

Q2. Is the tissue expansion process painful?

Ans. Most women do not find the injections themselves to be painful. You may feel a sensation of tightness or pressure in your chest for a day or two after each fill as the skin and muscle stretch, which is usually well-managed with mild pain relievers.

Q3. Will my reconstructed breast match my other breast perfectly?

Ans. The goal of reconstruction is to create the best possible symmetry. Your surgeon is highly skilled at this. However, a reconstructed breast and a natural breast will never be a perfect, identical match. To improve symmetry, your surgeon may recommend a procedure like a lift, reduction, or augmentation on your other breast.

Q4. Can I have reconstruction if I need radiation therapy?

Ans. Yes, but radiation can cause complications for implant-based reconstruction, such as hardening of the scar tissue capsular contracture and poor wound healing. Your surgeon will discuss the specific risks and timing with you. Sometimes, they may recommend delaying the final implant placement until after radiation is complete.

Q5. What are the main risks of implant reconstruction?

Ans. Risks include those of any surgery, such as bleeding and infection. Specific risks related to implants include implant rupture, capsular contracture hardening of the scar tissue, and implant malposition. It is important to remember that implants are not lifetime devices and may require replacement in the future.

Q6. Will I be able to feel anything in my reconstructed breast?

Ans. A mastectomy involves cutting the nerves to the breast skin and nipple, so a reconstructed breast will not have the same sensation as a natural breast. Over time, some protective sensation may return, but normal feeling does not.

Q7. Is breast reconstruction covered by insurance?

Ans. Yes. In India, as in many countries, breast reconstruction following a mastectomy is considered a reconstructive, not a cosmetic, procedure. It is a recognized part of breast cancer treatment and is generally covered by health insurance, including symmetry procedures on the opposite breast.

Q8. What is an Acellular Dermal Matrix ADM?

Ans. ADM is a processed and sterilized tissue scaffold, often derived from human or animal skin, that is used to support the breast implant during reconstruction. It acts like an internal sling or hammock, helping to control the implant's position and create a more natural-looking breast shape and fold.