Breast reconstruction restores the shape and appearance of the breast after mastectomy. It involves multiple surgical steps rather than a single operation. The time spent in the operating room varies greatly depending on the technique chosen, ranging from multi-stage implant placements to complex tissue transfers. The total duration includes both individual surgery times and the overall timeline of the reconstructive journey.
Duration of Implant-Based Procedures
Implant-based reconstruction is often performed in two stages requiring two separate surgeries spaced months apart. The first stage involves placing a tissue expander, a temporary device inserted beneath the chest muscle or skin. This initial surgery typically lasts about 1.5 hours for a single breast or two hours for a bilateral procedure. If the expander is placed immediately following a mastectomy, the overall operating room time increases to three to four hours.
The expander is gradually filled with saline over several weeks or months to stretch the skin and create a pocket for the permanent implant. The second stage is the exchange surgery, where the temporary expander is replaced with a permanent silicone or saline implant. This procedure is significantly shorter than the initial placement, often taking only one to two hours to complete.
The exchange surgery is often performed as an outpatient procedure, allowing the patient to go home the same day. The short duration and minimal recovery time are advantages of the implant pathway. If adjustments to the opposite breast are required for symmetry, the surgical time may be slightly extended.
Duration of Autologous Flap Procedures
Autologous reconstruction uses the patient’s own tissue and involves significantly longer operating room times due to complex tissue transfer. The Deep Inferior Epigastric Artery Perforator (DIEP) flap is a common and lengthy procedure. A unilateral DIEP flap surgery often takes between three and eight hours, sometimes longer, depending on the surgeon and the specific case.
If both breasts are reconstructed using the DIEP flap, the procedure typically lasts between five and ten hours. This extended time is necessary because the surgeon must carefully harvest tissue, including skin, fat, and blood vessels, from the lower abdomen. The blood vessels in the transferred tissue must then be reconnected to vessels in the chest using specialized microsurgical techniques.
The surgical duration can increase if the reconstruction is performed immediately following the mastectomy. Advances in surgical teams and technology have helped reduce the time for the DIEP flap from what was once an eight to ten-hour procedure. Other flap procedures, such as the Transverse Rectus Abdominis Myocutaneous (TRAM) flap or the Latissimus Dorsi (LAT) flap, also take several hours, reflecting the intricate nature of moving tissue and maintaining its blood supply.
Total Timeline and Ancillary Surgery Lengths
The entire breast reconstruction process is a staged treatment spanning months or over a year, far exceeding the time spent in the operating room. For two-stage implant reconstruction, the interval between the initial tissue expander placement and the exchange surgery is usually a minimum of three to six months. This period allows for the gradual expansion of the skin and muscle before the permanent implant is placed.
After the primary breast mound is created, smaller ancillary procedures are often necessary to refine the result. These surgeries are generally quick and usually performed as outpatient procedures. The reconstruction of the nipple and areola complex is one of the final steps, typically performed three or more months after the final breast mound surgery.
Nipple reconstruction surgery is a short procedure, often taking between 30 minutes to just over an hour. If both nipples are reconstructed, the time may extend up to 90 minutes. Further refinement is achieved through fat grafting, which involves harvesting fat from another area of the body and injecting it into the breast to improve contour or camouflage implant edges.
A single fat grafting session typically lasts between one and three hours, and multiple sessions may be required for desired volume or symmetry. These procedures are often spaced three to six months apart. After the nipple mound has healed, the final step is areolar tattooing, a non-surgical procedure lasting about 30 to 45 minutes to restore the color and definition of the areola.