Breast reconstruction after mastectomy is an important part of the care of women with breast cancer and promotes a positive body image. Replacing the breast can be an external breast prosthesis, breast implants, or a woman’s own skin and fat (a flap). Many women are candidates for immediate reconstruction; that means the first stage of reconstruction is done at the same time as the mastectomy. If your breast cancer is discovered early, you are more likely to be a candidate for immediate breast reconstruction. 
If there is a need for subsequent chemotherapy or radiation, reconstruction may need to be delayed until these treatments are completed. Chemotherapy and radiation can slow your ability to heal and change the final appearance of your reconstruction. In addition to radiation, smoking and obesity increase the chance of complications after any surgery, including breast reconstruction.
The choice of reconstruction with implants or a flap depends on many factors, including the size of opposite breast, the availability of tissue for a flap, the patient’s medical problems and patient preference.
If a woman chooses to have a breast implant for reconstruction, most will need placement of a tissue expander that can be inflated to the desired size over time, slowly stretching the skin. A subsequent surgery replaces the expander with a breast implant. 
For women that choose to have a flap, the most common source of tissue is the abdomen. Many women have excess fat and skin in their lower abdomen, especially after pregnancy. Flaps taken from here can provide enough tissue to reconstruct even a large breast. The transverse rectus abdominis myocutaneous (TRAM) (tummy tuck) flap and the deep inferior epigastric artery perforator (DIEP) flap include skin and fat from the lower abdomen. The DIEP flap uses the latest microvascular techniques in breast reconstruction and is not available in many hospitals.  Flap reconstruction generally requires a longer hospital stay than implant reconstruction.
Procedures on the other breast – reducing the breast size, a breast lift, or implant augmentation – may also be required to ensure both breasts are similar and enhance the aesthetic outcome.  Such procedures are recognized as an essential part of the reconstruction.
Whichever method of reconstruction is employed, the final stage involves creating a new nipple areola complex. A common option for reconstruction of the nipple is local tissue arrangement to reproduce nipple elevation. Finally, a new areola is created by tattooing and is generally done in the plastic surgeon’s office. Your plastic surgeon can work closely with you and your general surgeon to construct aesthetically pleasing breasts.