If you've been diagnosed with breast cancer and are preparing for a mastectomy (removal of the breast), or if you've already had a mastectomy, breast reconstruction is an important consideration. Breast cancer treatment decisions may seem overwhelming at times. As you consider your surgical options, try to evaluate your goals, realistic expectations and the long-term effects of breast reconstruction. For many women, reconstruction is an integral part of the recovery process. Regaining your health and restoring your body image is possible with a lot of care, patience and courage. Our goal is to help you understand your options since there are several reconstructive techniques that can be used following mastectomy.Federal law requires that breast reconstruction, including aesthetic changes to the unaffected breast, be covered by insurance. It is very important that all women understand that they are entitled to breast reconstruction and have different options for reconstruction. If only one breast is affected, it alone may be reconstructed. A breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry between both breasts. It is important to consider all of the reconstruction options before making a decision.Tissue Expander with a breast implant is the simplest form of breast reconstruction. In this procedure, a tissue expander is placed under the skin. Saline is added weekly to the expander, stretching the skin as it expands. When the skin has been sufficiently stretched, the tissue expander is removed at a second surgery and replaced by a permanent breast implant. Nipple reconstruction, if desired, is part of the second surgery. Latissimus Dorsi Myocutaneous Flap is a tissue flap procedure that uses muscle and skin from your upper back to create a new breast mound after a mastectomy. An ellipse of skin and the latissimus dorsi muscle is tunneled from the upper back to the mastectomy site to create a reconstructed breast. A tissue expander is placed under the flap, and saline is added weekly to the expander, stretching the skin as it expands. When the skin has been sufficiently stretched, the tissue expander is removed at a second surgery and replaced by a permanent breast implant. Nipple reconstruction, if desired, is part of the second surgery. Transverse Rectus Abdominus Myocutaneous Flap (TRAM flap) is a more involved method of breast reconstruction that utilizes the extra skin and soft tissue [fat] from the area of the lower abdomen. This is living tissue and in order to provide for the blood supply for this living tissue, one of the rectus abdominus muscles is used [the blood supply runs inside of it] and the overlying skin and fat is used to create the reconstructed breast mound. The goals is to create a reasonably sized breast mound. However, if the opposite breast is large and pendulous, it can be reduced in size by a breast reduction at a second surgery. Patients wishing to have this procedure must stop smoking six weeks prior to and six weeks following the surgery. Failure to comply may result in the death of the flap since it is living tissue. A synthetic mesh is placed over the area where the muscle was removed. This strengthens the abdominal wall and minimizes the chance of bulges.