FAQ

In our experience, almost all patients are potential candidates for breast reconstruction. The more accurate question is rarely whether reconstruction is possible, but when, and how to best prepare for it.

Candidacy depends on overall health, body composition, your cancer treatment plan, prior surgical history, and personal goals.

Several things shape candidacy:

• Overall health — cardiovascular health, blood sugar control, and other medical conditions.
• Body composition — weight and metabolic health, especially relevant for flap surgery.
• Cancer treatment plan — whether radiation is planned or already complete.
• Prior surgical history — previous abdominal, breast, or chest surgeries.
• Personal goals — what kind of result you want and what trade-offs you're willing to accept.

We work through each of these in detail during consultation.

In most cases, no. Patients are sometimes told they are not surgical candidates because of weight, blood sugar, or other modifiable factors, and are left with the impression that the door is permanently closed.

Modifiable factors are exactly that: modifiable. Helping patients improve their overall health before surgery can genuinely transform someone from a poor candidate into a good one. A second opinion is worth seeking.

Yes. Prior reconstruction does not disqualify you from revision or secondary reconstruction. Many patients come to us specifically because they have had a previous reconstruction elsewhere or at an earlier stage of their journey and are seeking improvement.

Each case is evaluated individually with a clear focus on what is realistically achievable.

A consultation at Altris begins with listening. Before we discuss options or examine anything, we want to understand your experience up to this point: what you have been through, what has been said to you, what has felt right or wrong, and what matters most to you going forward.

We then conduct a comprehensive review of your overall health, including medical history, lab work, metabolic health, exercise habits, and emotional wellbeing.

Finally, we discuss your options honestly, including what is realistically achievable and what trade-offs to consider. The final decision is always yours.

Most medical appointments follow a clear pattern: identify the problem, run standard diagnostics, recommend treatment. Reconstruction consultations don't work that way.

There is rarely one objectively correct decision. There are usually several reasonable options, and the most important factor in determining the right choice is you: your goals, your values, your life circumstances, and your priorities. Our job is to understand those things well enough to give you genuinely useful guidance, not just a menu of procedures.

Our consultations are built around the belief that what is on the chart tells only part of the story. We listen first, then conduct a thorough review of your overall health, then discuss your options honestly.

This approach is more extensive than a typical consultation because reconstruction outcomes are not determined solely in the operating room. The quality of preparation, the accuracy of the plan, and your overall health at the time of surgery all have a profound impact on results.

Implant-based reconstruction uses a breast implant, typically with soft tissue support.

Autologous (natural tissue) reconstruction uses your own tissue, usually from the abdomen, thigh, or back, transferred with its own blood supply using microsurgery.

Both are valid options with different advantages, trade-offs, and recovery profiles. The right choice depends on your anatomy, health, treatment plan, and personal goals.

Advantages

• Shorter initial recovery
• No donor site required
• More flexibility in adjusting breast size
• Wider availability across healthcare settings

Disadvantages

• Risk of implant-specific complications including capsular contracture, malposition, animation deformity, and rupture
• Implants are not lifetime devices — most patients will require at least one revision or replacement over time, particularly relevant for younger patients
• Results may change differently than natural breast tissue with age and weight fluctuation

Advantages

• Uses your own living tissue, which most closely resembles the look, feel, and behaviour of a natural breast
• Permanent reconstruction that evolves with your body — no lifetime maintenance or implant replacements
• Generally preferred after radiation therapy
• Can improve tissue quality in radiated areas over time through improved blood flow

Disadvantages

• Requires a donor site, meaning additional scarring
• Longer initial hospital stay
• Requires a surgeon with advanced microsurgical training

Autologous reconstruction is generally preferred after radiation. Implant complication rates are significantly higher in radiated tissue, while natural tissue reconstruction can actually improve tissue quality in radiated areas over time through improved blood flow.

There is no objectively correct answer. Useful questions to discuss with your surgeon include:

• Will I need radiation therapy?
• How important is avoiding a donor site scar?
• Am I comfortable with the possibility of future implant revisions?
• What are my long-term goals for how my reconstruction looks and feels?
• What does my anatomy allow for?

We walk through all of these during consultation, without steering you toward a predetermined answer.

Yes. Conversion from implant-based to autologous reconstruction is one of the most common secondary procedures we perform, particularly for patients experiencing capsular contracture, animation deformity, or radiation-related complications, or those who simply want a more natural, permanent result.

It is never too late to revisit the decision.

Yes, in many cases. While reconstruction after lumpectomy is more complex than after mastectomy, carefully selected patients can achieve meaningful improvements with the right techniques.

If you have been told nothing can be done, a second opinion is worth seeking.

When breast tissue is removed during lumpectomy, it leaves a void that surrounding tissue fills imperfectly. Radiation therapy compounds this by causing fibrosis, which is permanent scarring and reduced blood flow in the treated area.

The result can be dimpling, hollowing, asymmetry, skin tethering, or a visible deformity at the lumpectomy site. These changes are not simply cosmetic; they can affect how clothing fits, how the breast feels, and your overall sense of body image.

Fat grafting can help with smaller contour issues, though radiated tissue limits how well transferred fat survives, so it often plays a supporting role alongside other techniques.

For more significant deformities, local perforator flap surgery moves adjacent tissue with its own blood supply into the area of need:

• ICAP flap — uses tissue from the lateral chest wall
• TDAP flap — uses tissue from the upper back
• IMAP flap — uses tissue from the chest near the sternum

All three techniques involve relatively short recovery periods and well-concealed scars.

Breast reconstruction as a whole, from initial surgery through final refinement, typically spans multiple stages over one to two years, sometimes longer depending on treatment history, the need for radiation, and individual healing.

Most patients undergo a primary procedure followed by one or more refinement procedures over time. We discuss the full anticipated journey with every patient during consultation so there are no surprises.

For autologous flap reconstruction:

• Hospital stay — 2-3 nights
• Drain removal — 7-14 days (3-4 weeks for LAP flap)
• Return to light activity / desk work — 2 weeks
• Return to driving — 3 weeks
• Return to full activity and exercise — 4-6 weeks
• Final result visible — around 3 months

All flap patients are managed under our Enhanced Recovery After Surgery (ERAS) protocol, designed to reduce pain, minimise complications, and accelerate recovery.

Implant exchange is an outpatient procedure, so you go home the same day.

• Drain removal (if used) — 7-10 days
• Return to light activity / desk work — 2 weeks
• Return to driving — 2 weeks
• Return to full activity and exercise — 4 weeks
• Final result visible — around 3 months

Fat grafting is one of our most straightforward procedures. It is performed as an outpatient procedure with no drains required.

• Return to light activity — 1 week
• Return to full exercise — 3 weeks
• Final result visible — 6-8 weeks

Note that approximately 60% of transferred fat remains viable, so multiple sessions are often needed to achieve the optimal result.

Reconstruction is rarely a single surgery. Most patients undergo a primary procedure followed by one or more refinement procedures over time.

Each stage has its own recovery timeline, and we plan these carefully with each patient from the outset. Revision procedures to fine-tune the result are a normal and expected part of the process.

Our intake assessment goes well beyond the standard medical history. We evaluate:

• Metabolic health — blood sugar control, body composition, and indicators of recovery capacity
• Nutrition — diet quality, protein intake, and any deficiencies that could affect healing
• Sleep — quality, duration, and disruptions that affect recovery and pain tolerance
• Exercise capacity and mobility — strength, range of motion, and how your body moves
• Emotional and mental health — how you are processing your cancer journey and what support you have in place

All of it matters. All of it shapes what is possible.

Prehab is a structured preoperative optimization protocol: a tailored plan to improve strength, nutrition, metabolic health, and other modifiable risk factors in the months leading up to surgery.

The evidence is consistent: patients who arrive at surgery in better baseline condition have fewer complications and recover faster. Prehab is built into every patient's plan from the first consultation.

Posthab is post-surgical rehabilitation. Recovery does not happen by accident, so we continue the work that began with prehab.

Our posthab protocol supports a smoother, more complete recovery through guided return to activity, nutritional support, and ongoing assessment of how the body is responding.

Reconstructive wellness is the work that surrounds surgery: the careful, deliberate effort to understand the whole patient (nutrition, sleep, physical conditioning, metabolic health, and emotional readiness) and to optimize each of these in service of a better surgical result and a fuller recovery.

The principles are well established in the surgical literature; what is rare is the consistent application of them in everyday practice. We built Altris around it.

Some degree of asymmetry is common and often expected. Contributing factors include:

• One-sided reconstruction — a natural breast and reconstructed breast will always differ slightly
• Healing and scarring — capsular contracture or mastectomy-related scarring
• Radiation therapy — causes fibrosis and skin darkening, making perfect symmetry difficult
• Weight changes — reconstructed breasts don't respond to weight fluctuations the same way
• Implant complications — capsular contracture, malposition, rupture, or rippling on one side
• Pre-existing asymmetry — if breasts were not perfectly matched before surgery

Yes. Even in women who have never had surgery, perfect breast symmetry is unusual. Breasts are often more like sisters than twins.

That said, significant asymmetry after reconstruction can be addressed to improve both appearance and how you feel in and out of clothing. Reconstruction is rarely a single surgery, and revision procedures to fine-tune the result are a normal and expected part of the process.

Treatment depends on the cause and your goals. Where possible, we adjust the less favoured side to match the preferred outcome.

• Implant exchange or revision — removing and replacing the implant to improve size, shape, or position
• Reshaping after autologous reconstruction — refining the footprint, projection, and contour of a flap reconstruction
• Fat grafting — transferring your own fat to areas where volume or contour need improvement
• Mastopexy or breast reduction — lifting or reshaping the natural breast to match the reconstructed side
• Nipple reconstruction and tattooing — particularly useful in unilateral reconstruction

Animation deformity occurs when a breast implant placed behind the pectoral muscle moves unnaturally during muscle contraction. During activation of the pectoralis major — when lifting, pushing, or exercising — the implant flattens and shifts upward and outward.

In many patients, this displacement also affects the overlying skin and nipple, which can be visually distressing. It can also cause pain and chronic discomfort. It occurs significantly more often after reconstruction than after cosmetic augmentation.

Animation deformity has a single root cause: implant placement behind the pectoral muscle (the retropectoral plane), with or without the use of an inferior mesh or dermal sling.

As long as the implant remains beneath the pectoralis major, muscle contraction will continue to move it.

Treatment focuses on moving the implant in front of the muscle (the prepectoral plane) or removing it entirely, along with repairing the pectoralis major back to its natural position. Achieving the best result often requires more than one procedure.

• Implant plane change — moving the implant to the prepectoral plane
• Fat grafting — particularly useful in thinner patients to camouflage implant borders
• Biologic or synthetic support — ADM or P4HB mesh to reinforce contour
• Implant type upgrade — switching to a cohesive gel implant to reduce rippling
• Conversion to autologous reconstruction — for a permanent, implant-free solution

The right combination depends on your anatomy, surgical history, and goals.

Yes. Many of our patients come to us specifically because they have had a previous reconstruction elsewhere and are seeking improvement, whether for asymmetry, animation deformity, capsular contracture, or simply a result they're not happy with.

We evaluate each case individually and give you a clear, honest picture of what is realistically achievable.

Yes. The Women's Health and Cancer Rights Act (WHCRA) of 1998 is a federal law that requires any group or individual health plan covering mastectomy to also cover:

• All stages of reconstruction of the breast on which the mastectomy was performed
• Surgery and reconstruction of the other breast to achieve symmetry
• Prostheses and treatment of physical complications, including lymphedema

WHCRA covers both implant-based and natural tissue reconstruction.

Altris is a fee-for-service, out-of-network practice. We do not participate in any insurance networks.

This is a deliberate choice that allows us to spend the time each case requires (in consultation, planning, and the operating room) without the constraints of insurance contracts. For complex reconstruction and revision surgery, that time is the difference between a good outcome and a great one.

Often, yes. Being out-of-network does not mean you are on your own.

• Facility and anesthesia costs are typically covered directly by your insurance under WHCRA, regardless of whether your surgeon is in-network.
• The surgeon's fee is your direct responsibility, but if your plan has out-of-network benefits, you can submit it for reimbursement after deductible and coinsurance.
• We provide a superbill on request — an itemized receipt with all the procedure and diagnosis codes your insurer needs to process a claim.
• We help with pre-authorization and provide all documentation needed to submit a claim.

Call the member services number on the back of your insurance card and ask:

1. Do I have out-of-network benefits?
2. What is my out-of-network deductible, and how much have I met this year?
3. What is my out-of-network coinsurance percentage?
4. Is there an out-of-network out-of-pocket maximum?
5. Does my plan cover breast reconstruction under the Women's Health and Cancer Rights Act?
6. What documentation do I need to submit a claim for an out-of-network surgeon's fee?

Write down the answers, the date of the call, and the representative's name. This protects you if there is a dispute later.

It depends on your plan and the procedure. Fat grafting, nipple reconstruction, symmetry procedures, revision surgery, and correction of implant complications may not always be covered under WHCRA, and some insurers categorize them as cosmetic.

That said, we recommend submitting all charges to your insurance if you have out-of-network benefits. Coverage decisions vary, and some patients receive partial or full reimbursement for procedures their insurer initially categorizes as elective. We provide detailed documentation to support your claim.

The No Surprises Act is a federal law that took effect in 2022, designed to protect patients from unexpected medical bills, primarily when receiving care from an out-of-network provider at an in-network facility without prior knowledge. It also requires providers to give uninsured or self-pay patients a written estimate before scheduled care.

At Altris, we are transparent about our fees from the outset. Before you schedule surgery, you will know what your costs will be. There are no surprise bills.