The overall goal of breast reconstruction is a positive image and sense of well being for the patient. First, the patient and her doctor will identify and visualize the final end result. This involves understanding the size and shape of the breast you want. Some patients have specific desires while others are content with the mere suggestion of a breast mound. Some may opt for multiple procedures to achieve the ultimate result. Others may choose the simplest, easiest and shortest route.

In most cases, only one breast is affected by cancer. One of the first decisions is what to do with the "good" breast. This normal breast becomes the template for the reconstructed one.

Preventive (prophylactic) removal of the good breast may be recommended. For different patients and physicians the decision to do this will vary. The threshold for recommending prophylactic treatment is different for different physicians and different patients. For some, an increased risk over one's lifetime of developing a second primary cancer in the opposite breast is sufficient to warrant treatment. For others, the risk would need to be quite substantial to consider such a measure.

The pros and cons of prophylactic mastectomy should be discussed with the oncologist, oncological surgeon, and plastic surgeon. A plastic surgeon's input is crucial to the discussion. One of the ultimate ideal goals of breast plastic surgery is symmetry. Similar and symmetric procedures generally yield better symmetry.

The next issue how you feel about an implant versus using your own tissue for reconstruction. Some people have a bias for or against implants, especially silicone gel implants.

When a silicone gel implant works, it is better than saline implants in reconstruction. It looks, feels and acts more natural.

However, the gold standard for reconstruction is using your own tissue (autologous reconstruction) to rebuild the breast. The reconstructed breast may be virtually indistinguishable from the natural breast. There are a variety of techniques to achieve this result. They all require surgery that is more involved and complex than implants. This often will mean more scars.

Your plastic surgeon should be in the position to offer you all of the alternatives for implant or autologous tissue reconstruction.

Another important consideration is timing of the reconstruction. It used to be that all reconstruction was delayed at least six months. Now we recommend immediate reconstruction in most cases. In fact, any patient who does not want to live without a breast should consider immediate reconstruction.

Breast reconstruction is a quality-of-life issue. Many patients who see their rehabilitation begin at the same time the cure begins are emotionally and psychologically uplifted.

Advanced stages of cancer are not necessarily a reason to delay or withhold reconstruction. As long as the reconstruction does not interfere with or delay appropriate curative treatment, this life-enhancing surgery is appropriate.

Finally, delayed reconstruction is always more surgically difficult and demanding than immediate reconstruction.

Immediate reconstruction means beginning the reconstruction at the time of the mastectomy. It does not mean it is completed immediately. Usually, complete reconstruction requires two or three stages spaced no less that three months apart.

In those patients who desire reconstruction but cannot decide on or commit to a specific method, the initial reconstruction phase should at least consist of insertion of a spacer, either an implant or an inflatable expander.