The answer to this question depends on the type of reconstruction you undergo. If you are a candidate for a direct to implant reconstruction, the final implants are placed at the time of the initial surgery. If you require a tissue expander, then a subsequent procedure will be required to exchange the expander for a permanent implant. Regardless of the type of reconstruction, however, many patients elect to undergo anywhere from 1-3 rounds of fat grafting to improve the contour of the reconstructed breast. The mastectomy interrupts the natural softness of the breast, leading to the harsh and unnatural appearance often seen following implant only reconstruction.
Fat grafting involves the removal of fat from elsewhere on your body (most commonly the abdomen) using liposuction and transplanting it to your breasts. The transplanted fat re-establishes the natural softness to the breast contour over the implant. Unfortunately, only approximately 40% of this fat survives the relocation procedure, meaning a second and rarely a third round of fat grafting is often required. It is worth mentioning that approximately 1 in 12-15 patients experiences a complication (infection, skin loss, seroma and capsular contracture just to name a few) following breast reconstruction. This rate is consistently supported by the plastic surgery literature and depends on a variety of pre-disposing factors that we will discuss during your consultation. The need for post-operative radiation can further increase this risk. Any post-operative complication may increase the number of procedures required to achieve a stable reconstructive result.