Breast Reconstruction in Beverly Hills

Performed at the same time as mastectomy, with an implant ("direct-to-implant"), a tissue expander, or an immediate flap. For most patients, this is the approach Dr. Killeen recommends.

Benefits: There is no period of time without a breast, and because the skin has not had time to shrink and scar, fewer surgeries are usually needed to reach the final result. Cancer outcomes are the same as with delayed reconstruction.

Trade-off: Complication rates are somewhat higher than with delayed reconstruction, driven mostly by how the mastectomy skin heals, which is why the skill of the breast surgeon matters. Learn why immediate reconstruction is right for most patients.

Performed months or years after the mastectomy, once treatment is complete or when you feel ready.

When it makes sense: A very aggressive cancer that needs chemotherapy or radiation right away, significant health conditions, or personal preference. Delayed reconstruction usually needs more surgeries to reach the final result, because the skin has had time to shrink and scar.

Uses breast implants, sometimes with tissue expanders, to create the breast mound. Often combined with acellular dermal matrix for support. It is the most common type of reconstruction in the U.S.

Uses your own tissue from the abdomen, thighs, back, or buttocks to sculpt a natural-feeling breast.

Uses only the skin and fat already on the chest, with no implant and no second surgical site. A SWIM flap shapes this tissue into a smaller breast mound; aesthetic flat closure creates a smooth, flat chest.

This technique allows patients to wake up from mastectomy surgery with reconstructed breasts and no tissue expanders. Dr. Killeen performs direct-to-implant reconstruction for most of her immediate reconstruction patients, and for most of them the reconstruction is complete in that single surgery. Some choose fat grafting a few months later to refine the shape.

Benefits include:

• Immediate results: No expanders, and a single surgery for most patients
• Size flexibility: You can come out smaller, the same, moderately larger, or more lifted than before; going dramatically larger may require an expander first. More on size options with direct-to-implant.
• Muscle-sparing placement: Implant positioned above the muscle, which avoids the visible muscle movement that under-the-muscle implants can show after a mastectomy. See over versus under the muscle.
• Internal bra support: Acellular dermal matrix provides stability
• Sensation-restoring option: Nerve grafting, planned at the time of mastectomy, can help some sensation return. Learn how nerve grafting works.

A temporary expander is placed at mastectomy and gradually filled to stretch the skin, then replaced with an implant in a second surgery. Dr. Killeen uses direct-to-implant reconstruction for most patients and reserves expanders mainly for cases where the blood supply to the mastectomy skin is uncertain or a much larger size is the goal.

Uses your own tissue for a natural shape and feel, with no implant to maintain. It is a longer operation with a second surgical site, and not every patient is a candidate. Common flap options include:

Uses liposuctioned fat to refine contour, improve symmetry, soften implant edges, or camouflage rippling. It is usually done as a separate procedure several months after reconstruction and can be repeated if needed. The area the fat is taken from is sore for a while and needs a compression garment for about a month. Learn about fat grafting to the breast and fat grafting complications.

An implant-free reconstruction done at the time of mastectomy, using the skin and fat already on the chest to create a smaller breast mound with no second surgical site. It is best suited to larger breasts that sit lower on the chest, and fat grafting can be added later for more volume.

For women having a lumpectomy, especially a larger one, a breast reduction or lift at the same surgery can reshape the breast and bring the other side into balance, preventing the asymmetry that often shows up after radiation. Oncoplastic reductions do not have worse cancer outcomes. If you are planning a lumpectomy, ask for a plastic surgery consultation before your cancer surgery. Learn more about oncoplastic reduction.

3D nipple-areola tattooing recreates the look of a nipple and areola with realistic shading and detail, and it is often the final step that makes a reconstruction feel complete. Surgical nipple reconstruction creates a small raised nipple, but it stays permanently firm and projected, which is why Dr. Killeen now favors 3D tattooing. Compare nipple reconstruction options.

• Mastectomy skin healing problems, flap loss, or delayed healing
• Implant issues (capsular contracture, rupture, rippling, implants settling out of position, asymmetry)
• Numbness: sensation is reduced after any mastectomy; nerve grafting can help some of it return, but it does not return to normal
• Rare risks with implants (BIA-ALCL, BIA-SCC, breast implant illness)

Reconstructed breasts are expected to feel firmer than a cosmetic augmentation, because there is less tissue covering the implant and reconstruction implants are intentionally firmer. A breast that becomes hard, rather than firm, may be capsular contracture and should be examined. Learn why reconstruction implants feel firmer.

Dr. Killeen will review these risks and create a personalized plan to minimize them based on your specific situation.

That plan can include quitting smoking and nicotine well before surgery, placing the implant above the muscle when appropriate, and infection-prevention steps in the operating room such as no-touch implant insertion. No surgeon can prevent every complication; when one happens, the goal is to recognize it early and manage it well. Problems that remain once you have healed can often be improved with a reconstruction revision.