After or during a mastectomy, some women may choose to have breast reconstruction, in which a surgeon will either use an implant, autologous tissue (tissue from another place in the body), or a combination of both to reconstruct the breast. 
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Immediate vs. Delayed Reconstruction 
 
Immediate reconstruction is when a surgeon performs breast reconstruction at the same time as a mastectomy. 
Although most women can usually consider immediate reconstruction, some women are ineligible:
-for example, women with inflammatory breast cancer cannot get breast reconstruction until they have received post-mastectomy radiation therapy and their skin has recovered, which can take 6 months to a year. 

Delayed Reconstruction is when reconstruction is performed after a mastectomy (in a separate procedure). 

To decide which surgery is right for you, talk to your oncologist. Some factors that might effect this decision are: 
-a physical exam 
-risk level (smoking, weight, etc.) 
-the type of breast cancer you have
-how advanced your breast cancer is

Types of Reconstruction
There are two main types of reconstruction:
implant reconstruction: an implant is inserted into the empty space in which the breast tissue used to be 
autologous/tissue: tissue from another place in the body is used to fill the empty space where the breast tissue used to be

Which Procedure is Right for You? 
Your doctors will help you decide if reconstruction is a possibility for you and, if so, which type of reconstruction is best for you. Some factors that may affect this decision are: 
-smoking
-obesity 
-diabetes 
-patient preferences 
-body habitus (some patients don't have enough extra tissue for autoogous reconstruction) 
-if you will need radiation (autologous reconstruction tolerates radiation better, and usually radiation must be done prior to implant reconstruction. 

Implant Reconstruction

Implant Reconstruction Risks 
-lifelong risk of infection 
-bacteria in the blood may go to the implant (bacteremia) 
-capsular contracture: thick scar tissue may develop around the implant, and it can become painful or change the shape of the breast 
-implants can rupture 
-breast implant illness (rare): medical issues such as fatigue, headaches, aches, brain fog, etc. 
-(very rare); small correlation between implants and anaplastic large cell lymphoma (ALCL), a type of blood cell cancer

Saline vs. Silicone Implants 
Although silicone implants used to be seen as dangerous, they have been proven to be safe (relative to saline). 

Silicone Implants 
Advantages
-softer than saline 
-look and feel more like natural breasts
-less risk of rippling (waviness of the skin around the implant) 
Disadvantages 
-higher risk of capsular contracture (thick scar tissue may develop around the implant, and it can become painful or change the shape of the breast) 
-hard to tell if it has ruptured (silent rupture) (many patients need an MRI every three years to ensure the implant has not ruptured)  
-ruptured implants can cause pain, breast thickening, and changes in shape of breast
-some studies have shown a correlation between silicone implants and autoimmune diseases

Saline Implants 
Advantages 
-less likely to rupture 
-rupture is easy to notice (breast will flatten) 
-if rupture occurs, saline solution is harmless and will be reabsorbed into the blood stream
-typically less expensive than silicone 
-smaller surgery scar
Disadvantages 
-look/feel firmer than natural breasts
-higher chance of skin rippling (waviness of the skin around the implant) 
-you may feel water sloshing 
-silicone casing (still a slight correlation with autoimmune disorders) 

Autologous Implants 
Surgeons will use tissue from another place in the body (such as the belly, back, underarm, thighs, or buttocks) to fill the empty space where the breast tissue used to be. 

Risks of Autologous Implants 
-blood clots
-weakness at the donor site 
-if tissue is take from the abdomen, a hernia is possible
-tissue flap necrosis (tissue at the flap can die, causing blue or black skin and/or open wounds; very rare- if it occurs, area of necrosis can be removed) 
-fat necrosis (thick scar tissue can form if blood supply to fat used to construct breast is cut off) (may go away on its own; if not, lump is usually removed) 
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What if I don't have enough tissue for an Autologous Implant? 
What about women who are very thin or have very large breasts, and therefore do not have enough extra tissue from one area? 
-some surgeons may combine an implant with autologous tissue 
-some very specialized surgeons can stack tissue from different parts of the body (however, this is a very difficult procedure and is not widely available)