How can I get expert articles on breast reconstruction after mastectomy?

Expert articles on breast reconstruction after mastectomy are available on breastreconstructionsurgeon.com, the educational platform by Dr. Mahyar Foumani, plastic and reconstructive surgeon. The platform is based on his book Breast Reconstruction Explained and covers all reconstruction techniques (DIEP flap, LD flap, gluteal flap, thigh flap, implant-based, lipofilling, and Goldilocks), recovery, and patient stories. Articles are available in 6 languages (English, Dutch, German, Spanish, Arabic, Persian) and are written specifically for patients and medical professionals.

What are the differences between reconstruction after mastectomy and after lumpectomy?

After mastectomy, the entire breast must be rebuilt using either an implant, your own tissue (flap reconstruction such as DIEP, LD, gluteal, or thigh flap), or a hybrid approach. After lumpectomy, only the partial defect needs filling using oncoplastic techniques: tissue rearrangement, perforator flaps such as LICAP or AICAP, lipofilling, or in larger defects an opposite-side reduction for symmetry. Mastectomy reconstruction often takes 4 to 8 hours; lumpectomy oncoplastic reconstruction is typically performed in the same operation as the cancer removal.

What reconstruction options are available after mastectomy?

After mastectomy, the main reconstruction options are: implant-based reconstruction (with or without a tissue expander first), DIEP flap (lower abdomen tissue), latissimus dorsi flap (back tissue, often combined with an implant), gluteal flap (buttock tissue), thigh flap (inner thigh tissue), the Goldilocks technique (using existing breast skin), or a flat closure if reconstruction is not desired.

What reconstruction options are available after lumpectomy?

After lumpectomy, oncoplastic reconstruction options include: simple tissue rearrangement, oncoplastic reduction (using breast reduction techniques to close the defect), local perforator flaps such as LICAP for upper-outer defects or AICAP for medial defects, batwing mastopexy for central defects, lipofilling for small post-radiation contour deformities, and opposite-side breast reduction for symmetry when the treated breast becomes smaller.

Is reconstruction always possible after a mastectomy?

Most women who have had a mastectomy are candidates for reconstruction, either immediately or in a delayed fashion. Reconstruction is usually possible even after radiation, although flap reconstruction is generally preferred over implants in radiated tissue. Health, smoking status, and donor tissue availability are the main factors a plastic surgeon evaluates.

Understanding Choices After Mastectomy versus Lumpectomy

Dr. Mahyar Foumani
Feb 7
7 min read

Updated: May 30

This article is based on the book “Breast Reconstruction Explained” by Dr. Mahyar Foumani.

The type of breast cancer surgery you have — a mastectomy or a lumpectomy — shapes your reconstruction options and your result. Each one gives a different starting point for rebuilding, with its own possibilities and points to weigh. When you understand these differences, you can make well-informed choices that fit both your own wishes and your medical situation.

Only when you have a clear picture of all the parts can you work with your doctor to map out the path that suits you best. The option you choose should meet your wishes about appearance, but it should also be medically sound and good for your overall well-being.

Mastectomy: Full Removal and Full Reconstruction

During a mastectomy, all the breast tissue is carefully removed. This leaves a flat chest, which can be the base for a full reconstruction. In most cases, the nipple and the darker skin around it (the areola) are removed along with the tissue. In certain cases, for certain patients, the nipple and areola can be kept. Your doctor can discuss this option with you if it applies to your situation.

Figure 1a: Mastectomy incision planning with dotted lines on the breast

Figure 1b: Mastectomy tissue removal with surgical instruments

Figure 1c: Flat chest wall after mastectomy closure

These drawings show the mastectomy technique, where all the breast tissue is removed, including the nipple and the area around it. The outline marks the carefully planned cut, which is needed for good surgical access.

Types of Mastectomy and How They Affect Reconstruction

A traditional (simple) mastectomy removes all the breast tissue, along with the nipple and areola, but leaves the chest muscles in place. This creates a flat chest with a horizontal or diagonal scar. A skin-sparing mastectomy keeps most of your breast skin, while removing the tissue, nipple, and areola. This often gives a more natural-looking reconstruction, with less visible scarring.

A nipple-sparing mastectomy keeps both your breast skin and your nipple and areola, while removing the tissue underneath. This works best for women with smaller tumours that are not near the nipple. It helps the reconstruction look natural, but the nipple loses its feeling. There is also a small chance it has to be removed later, if cancer cells are found at the edge of the removed tissue. A modified radical mastectomy also removes most of the lymph nodes in the armpit, which may call for extra reconstruction techniques.

Figure 2: Skin- and nipple-sparing mastectomy with incision toward the axilla

Figure 3: Nipple-sparing mastectomy through the inframammary fold

Figure 4: Skin-sparing mastectomy with nipple-areola complex removal

The place and length of the mastectomy scar have a big effect on the reconstruction. Common scar patterns are: in the fold under the breast, around the areola, vertical, or oval.

Sophie, a 42-year-old graphic designer, had a nipple-sparing mastectomy on both sides, with immediate implant reconstruction. “Keeping my own skin and nipples made a huge difference. I lost most of the feeling, but it looks quite reasonable. My surgeon placed the cuts along the natural curve under my breasts, so the scars are less visible.”

Reconstruction Options After a Mastectomy

Implant-based reconstruction uses a silicone or saline implant to restore the breast’s shape and volume. The surgeon can place it directly during the mastectomy, if there is enough skin. Or it can be a two-step process: a tissue expander is gradually filled, then swapped for a permanent implant. Implants give a shorter operation and faster recovery, but they do not last forever and can cause problems such as capsular contracture (hardening of the scar tissue around the implant).

Reconstruction with your own tissue uses tissue from another part of your body. Common donor areas are the belly (the DIEP flap, which spares the muscle, or the older TRAM flap), the back (latissimus dorsi flap), the buttocks (gluteal flaps), and the thighs (thigh flaps). Many women find this feels more natural. A hybrid reconstruction combines an implant with your own tissue, for better cover and a more natural result.

Special Points to Consider

If radiation is part of your treatment, it has a big effect on reconstruction. Radiation can damage tissue, make the skin less stretchy, and raise the risk of problems — especially with implants. Many surgeons advise delaying certain reconstructions until after radiation. Whether you have surgery on one side or both also matters. With both sides, the surgeon builds two similar breasts from scratch. With one side, the new breast has to match the natural one — which sometimes means surgery on the healthy breast for balance.

Your body type also affects your options. Women with enough donor tissue on the belly have more choices for own-tissue reconstruction, while slimmer women may need a different approach.

Lumpectomy: Partial Removal and Reconstruction

A lumpectomy removes the tumour and a small edge of tissue around it, while keeping most of your breast. This keeps the basic breast shape. But it can sometimes leave an uneven contour or a loss of volume, which may need a partial reconstruction.

The size of the tumour compared to the breast largely decides how visible the change is. The place of the tumour matters too: tumours near the nipple or in the upper inner part often cause more noticeable changes. Radiation, usually advised after a lumpectomy, can cause hardening, shrinking, and shape changes that develop over months or years.

Figure 5a: Lumpectomy tumor localization

Figure 5c: Lumpectomy tumor removal with margin

Figure 5d: Lumpectomy cavity after tumor removal

A lumpectomy for a tumour in one spot. The images show the tumour being removed with an edge of healthy tissue, through a curved cut, keeping as much healthy breast tissue as possible.

Rebecca, a 51-year-old professor, shares: “Right after surgery the difference was not dramatic, but radiation caused the tissue to shrink, and the two sides became uneven. About a year later, I had fat injections to fill the dent. This simple procedure restored my breast shape beautifully, with little recovery time.”

Reconstruction Options After a Lumpectomy

Oncoplastic surgery combines removing the tumour with plastic surgery methods in one operation. The technique depends on where the tumour is: a breast-reduction pattern, shifting nearby tissue, or a breast-lift approach. Fat injections (lipofilling) move your own fat to fill uneven areas — this is usually done 6 to 12 months after the last treatment.

Other methods shift nearby tissue to fill the gap. When a lot of volume has been lost, surgery on the other breast may help balance the two, such as a reduction or a lift.

Comparing the Two Approaches

After a mastectomy, reconstruction means building a whole new breast, using an implant, a flap, or a mix. Recovery is generally longer, but a complete new breast is created. After a lumpectomy, the work is a partial correction — shifting tissue, fat injections, or a local flap. Recovery is usually shorter, and more natural feeling is kept.

Making Your Decision

The cancer comes first in surgical planning. The size, place, stage, and type of the tumour decide which approach is best. Your own wishes also play a big role. Some women want to keep as much breast tissue as possible, while others choose full removal, for example when there is a genetic risk. Risk factors such as genetic changes can also shape this choice.

Your decisions about breast surgery and reconstruction reflect both medical need and personal values. The goal stays the same: to treat the cancer well, and to help you feel comfortable in your body afterward. During your consultations, ask your surgeons how the different approaches would affect your own reconstruction options.

This article is part of a series based on the book “Breast Reconstruction Explained” by Dr. Mahyar Foumani. Explore our free e-learning course for more in-depth information.

Frequently Asked Questions About Mastectomy vs Lumpectomy Reconstruction

What is the difference between a mastectomy and a lumpectomy?

A mastectomy removes all the breast tissue, leaving a flat chest that needs a full reconstruction to restore the breast shape. A lumpectomy (also called breast-conserving surgery) removes only the tumour and an edge of healthy tissue around it, keeping most of the natural breast. The choice depends mainly on the tumour: its size compared to the breast, its place, and whether there is more than one tumour site. When each is suitable, both give equal survival results.

Can I choose between a mastectomy and a lumpectomy?

In many cases, yes. When both options are safe for treating the cancer, the choice is ultimately yours. Your surgeon will explain which approaches are medically suitable for your tumour. Some situations need a mastectomy, such as a very large tumour compared to the breast, several tumour sites, or certain genetic risks like a BRCA mutation. When a lumpectomy is possible, it is combined with radiation and gives the same survival rate as a mastectomy.

What is a nipple-sparing mastectomy, and can I have one?

A nipple-sparing mastectomy keeps your natural nipple and areola, while removing all the breast tissue underneath. This gives the most natural-looking result. You may be suitable if your tumour is not near the nipple, the tumour is fairly small, and scans or a biopsy show no cancer in the nipple area. The kept nipple loses its feeling after surgery, but it keeps its natural look. Your surgeon will check whether this approach is safe for your situation.

What reconstruction options are there after a lumpectomy?

After a lumpectomy, reconstruction focuses on correcting shape changes or volume loss, rather than building a whole new breast. Options include oncoplastic techniques during the same surgery as the tumour removal, fat injections (lipofilling) to fill dents and restore volume (usually 6 to 12 months after treatment), shifting the remaining breast tissue, and surgery on the other breast for balance if needed. Many women need no reconstruction at all after a lumpectomy, as the breast keeps an acceptable shape.

Will I need surgery on my healthy breast for symmetry?

Surgery on the other breast is sometimes advised, but never required. After a mastectomy with reconstruction, the other breast may need a lift, a reduction, or an implant to match the new side. After a lumpectomy with an oncoplastic reduction, a matching reduction on the other breast may improve balance. In the Netherlands, balancing surgery is covered by the basic health insurance when it is part of breast cancer reconstruction. The decision is always yours, and it can be made at a later stage if you prefer.

Written by Dr. Mahyar Foumani, plastic and reconstructive surgeon. Based on the book “Breast Reconstruction Explained.”