Breast Reconstruction Pathways

One option for rebuilding the breast after a mastectomy is through the use of implants. In this type of reconstruction, silicone or saline implants are placed beneath the skin or chest muscle to restore the shape and contour of the breast.

Implant-based reconstruction is the most common approach in the United States. It can be done in different ways depending on your body, treatment plan, and personal preferences.

Tissue Expander Method (Two-Stages)

For many women, implant reconstruction happens in two steps. This is sometimes called the tissue expander method.

Step One: Tissue Expander Placement

• During the mastectomy, or in a later surgery, your surgeon places a temporary tissue expander beneath the skin or chest muscle.

• The expander is like a balloon with a small valve.

• Over the course of several office visits, the surgeon gradually fills the expander with saline (salt water).

• This slow expansion gently stretches the skin and muscle, creating enough space for a permanent implant.

• Most women describe the process as manageable, though some feel temporary tightness or pressure after fills.

Step Two: Permanent Implant Placement

• Once the skin and muscle have stretched enough—usually within 2 to 6 months—the expander is removed.

• A permanent breast implant (silicone or saline) is placed in its place.

• This second surgery is usually shorter and easier to recover from than the initial mastectomy.

Direct-to-Implant Reconstruction (Single-Stage)

Sometimes, surgeons can skip the tissue expander step and place the permanent implant immediately during mastectomy surgery.

• Benefits: Fewer surgeries, no need for expansion visits, and immediate breast shape.

• Limitations: Not everyone is a candidate—this depends on your skin quality, breast size, overall health, and whether you’ll need radiation therapy.

Supporting Materials: Acellular Dermal Matrix (ADM)

To help hold the implant or expander in place, many surgeons use a special material called acellular dermal matrix (ADM).

• What it is: A mesh-like support made from donated human or pig skin.

• How it works: ADM acts like a sling or hammock, supporting the implant, giving it shape, and reducing the chance it will shift.

• Safety: The material is carefully processed so that all cells are removed, making it safe and reducing the risk of rejection or infection.

Things to Keep in Mind

• Multiple procedures: Even with implants, you may need revisions in the future. Implants are not lifetime devices and may eventually need replacement.

• Radiation impact: If you need radiation therapy, implants may not heal or look as well as other methods of reconstruction.

• Differences from natural breast tissue: Reconstructed breasts with implants may feel firmer, cooler, or move differently.

• Symmetry procedures: Sometimes surgery is also done on the opposite breast to create a more balanced appearance.

A Personal Decision

Implant reconstruction can be the right choice for women who want a shorter initial surgery, prefer not to use tissue from other parts of the body, or who like the ability to adjust breast size during the expander stage.

Others may choose flap (tissue-based) reconstruction or going flat instead. There’s no single right answer—it’s about what feels right for your body, lifestyle, and healing journey.