Breast reconstruction with tissue expanders
This method takes advantage of the skin’s ability to gradually stretch, similar to the expansion of abdominal skin during pregnancy. The tissue expander may be placed either immediately at the time of mastectomy or later, six or more months afterward. In both cases, it is inserted through the mastectomy incision, beneath the pectoralis major muscle, without creating additional cuts.
The expander is gradually inflated with saline through a small valve placed beneath the skin, slowly stretching the tissue and stimulating new skin formation to cover the defect. This process may take several weeks to a few months.
Once sufficient expansion is achieved, the expander is removed during a second operation and replaced with a permanent implant. In some cases, permanent expanders may be used to avoid a second procedure, but this option must be carefully discussed with the plastic surgeon, as it is not suitable for every patient.
In a later stage, reconstruction of the nipple–areola complex is performed.
In certain cases where there is significant excess skin after mastectomy, the surgeon may place the permanent implant directly during the first procedure, without the need for tissue expansion.

Breast reconstruction using the latissimus dorsi muscle
When tissue expansion is not possible or not preferred — for example, if the skin has been irradiated — reconstruction may be performed using a myocutaneous flap from the latissimus dorsi muscle.
In this procedure, a segment of skin from the back is transferred along with part of the latissimus dorsi muscle to ensure adequate blood supply. The muscle and an oval-shaped skin island are tunneled beneath the skin of the armpit to the front of the chest, creating a pocket to hold a silicone implant or, in some cases, a tissue expander if additional skin is required.

The disadvantages of this method include the formation of an additional scar on the back, multiple scars on the breast, and possible skin color mismatch, as back skin differs in tone from chest skin.
The back incision is typically closed horizontally.

Breast reconstruction using the rectus abdominis muscle
With this technique, no silicone implant is required. It is particularly suitable for patients with excess fat and skin in the lower abdomen and allows reconstruction of even large, ptotic breasts with a more natural shape compared to implants.
The skin and fat of the abdomen are transferred along with the rectus abdominis muscle and its blood vessels through a tunnel created beneath the skin to the chest. The abdominal scar resembles that of a classic abdominoplasty.
The disadvantages include the complexity of the operation, longer hospital stay, and additional scars on both the abdomen and the breast.
The main advantage is a more natural aesthetic result, especially for larger reconstructed breasts.
A variation of this technique involves free tissue transfer from the abdomen to the breast with microvascular reconnection of blood vessels. This is an even more complex procedure, and complications may result in complete loss of the graft.

Often, surgery on the opposite breast (reduction, lift, or augmentation) is necessary to achieve breast symmetry.

After complete healing of the breast wounds — usually 3–6 months after the final procedure — reconstruction of the nipple and areola is performed. This is typically done under local anesthesia using small local skin flaps to form the nipple, while the areola is recreated using medical tattooing.