Breast Reconstruction

Breast Reconstruction in Nashville, TN, with Dr. Michael Cash

Breast reconstruction is surgery to recreate the breasts after mastectomy or to restore the size and shape of the breasts after lumpectomy. The diagnosis and treatment of breast cancer can be traumatic.

When breast tissue is removed, the experience can leave a woman feeling disfigured. Breast reconstruction is designed to make a woman feel whole again after cancer treatment, and to restore her self-confidence and pride in her body.

To learn more about breast reconstruction and how it might benefit you, contact Nashville Plastic Surgery today to schedule a consultation with Michael Cash, M.D. Dr. Cash has attained certification from the American Board of Plastic Surgery. He has the training and expertise to perform complex reconstructive surgery and customized cosmetic procedures with remarkably natural-looking results.

Why Might I Consider the Best Breast Reconstruction in Nashville?

Choose Dr. Cash for Breast Reconstruction Surgery

Your choice of breast reconstruction surgeon is the paramount decision you’ll make in the process. Ample experience with this procedure is crucial. Always choose a surgeon who is board-certified through the American Board of Plastic Surgery (ABPS), which is the only valid board certification for a plastic surgeon. 

Choose a surgeon who listens and whose results demonstrate a flexible and customized approach. A skilled surgeon will tailor the details of each procedure to your unique needs and desires. As the best breast reconstruction surgeon in Nashville, Dr. Cash will spend time with you to understand the results you hope to achieve. He’ll explain what you should realistically expect, plus the risks and costs. He equips his patients with the knowledge they need to confidently make decisions, always treating everyone with respect and attention. 

What Does Breast Reconstruction Surgery Involve?

Breast Reconstruction surgery has several techniques and the technique chosen will determine the extent of the operation and recovery. The most common type of breast reconstruction is a tissue expander followed by a breast implant. This is performed in two separate operations.   Flap surgery using your own breast tissue is a longer operation with a longer recovery time but may avoid having a breast implant. Finally, if you are having a lumpectomy, the breast may be reshaped to fill in the defect caused by the lumpectomy and the other breast is lifted and reduced to match the affected breast.   

Breast reconstruction surgery may be performed at the same time as your cancer operation.  The breast cancer surgeon will perform the cancer operation and Dr. Cash will perform the reconstruction after the cancer surgeon is finished, but at the same operation. If the technique used is a tissue expander followed by an implant, then the tissue expander is placed under the muscle at the first operation. The patient typically stays just one night in the hospital and will go home the next morning.  If a flap operation is used the patient can expect to stay in the hospital for several days to check on the flap. If an oncoplastic reconstruction is used, where the breast is reshaped after a lumpectomy, the patient often goes home the same day.    

Dr. Cash will work together with your cancer surgeon to determine the appropriate incisions.  You should expect to see Dr. Cash and your breast cancer surgeon again the morning of the operation.  Breast reconstruction surgery with implants typically takes about two hours. Flap reconstruction using transplanted tissue takes longer, generally between four and ten hours.  The sutures are all under the skin and absorbable.  You may have drains after the operation which may last up to 2 weeks. After the operation you will be in the recovery room for approximately an hour.  Depending on the operation you may be admitted to the hospital or allowed to go home the same day. You will continue to see Dr. Cash for several weeks following the operation to monitor your reconstruction.  

How Is Breast Reconstruction Done?

Several techniques are used for breast reconstruction. The choice of which to use will come down to the nature of the changes to be made, Dr. Cash’s determination of the safest and most effective approach, and your preferences. 

The two main approaches to breast reconstruction are flap reconstruction, which uses tissue from another part of your body to recreate the breast, and implant reconstruction, which uses a saline or silicone implant to restore breast volume. Tissue and implant reconstruction are often combined in breast reconstruction. Additional techniques can be used to recreate the nipple and areola. 

Flap reconstruction involves moving tissue from another part of your body to form the restored breast shape. Sometimes this is done by moving the transplanted tissue through your body (pedicled flap) so that it retains its original blood supply while it becomes established in the breast. Sometimes the transplanted tissue is detached from its original position (free flap) and attached to blood vessels in your chest. Tissue for breast reconstruction can be transplanted from your belly, back, thighs, or buttocks. 

The different types of flap reconstruction are named for the parts of the body from which the tissue is moved. These include:

  • Latissimus dorsi (LD) flapSkin, fat, blood vessels, and muscle are moved to the breast through a tunnel under the skin from the upper back, retaining the connection to the original blood supply.
  • Transverse rectus abdominal muscle (TRAM) flap — Skin, fat, blood vessels, and muscle are moved to the breast from the lower belly.
  • Deep inferior epigastric perforator (DIEP) flap Skin, fat, and blood vessels, but not muscle, are moved to the breast from the lower belly.
  • Superficial inferior epigastric artery (SIEA) flap — Much the same as a DIEP flap but including different blood vessels.
  • Inferior gluteal artery perforator (IGAP) flap — Skin, fat, and blood vessels are moved from the lower buttocks to the breast.
  • Superior gluteal artery perforator (GAP) flap — Skin, fat, and blood vessels are moved from the upper buttocks to the breast.
  • Transverse upper gracilis (TUG) flap — Skin, fat, blood vessels, and muscles are moved from the upper inner thigh to the breast.
  • Profunda artery perforator (PAP) flap — Skin, fat, and blood vessels, but not muscles, are moved from the upper inner thigh to the breast.

Implant reconstruction involves the placement of saline or silicone implants to create breast volume. This is the most common technique for breast reconstruction and involves the least downtime.

  • Typically this is a two staged operation.  At the first operation a tissue expander may be used to gradually expand the skin of the breast before the implant is placed. This basically creates a space where the final breast implant will be inserted.  Placing the tissue expander under the chest muscles has a lower rate of infection and complications and is the typical placement of the expander by Dr. Cash.
  • The implant may be placed under or above your chest muscles. However, placing the implant under the muscle decreases the rate of infection, capsular contracture, and has fewer incidences of visible rippling of the implant.
  • Acellular dermal matrix (ADM) tissue may be used to add support within the breast to hold the implant in place, though this is not typically used by Dr. Cash.. 
  • In some cases, transplanted tissue from another part of your body may be used to extend the skin and muscle to cover the implant and hold it in place.
  • Fat transfer from another portion of the body can be used to complement this reconstruction but is not used as the primary means for recreating the breast. 

Oncoplastic reconstruction after lumpectomy reshapes the breast when the breast is retained but tissue is removed as part of cancer treatment. The techniques used are similar to those used for a breast lift or breast reduction.  It reshapes the breast to fill in the defect left after the breast cancer is removed.  The remaining breast tissue is positioned to fill in the lumpectomy cavity.


A breast lift or breast reduction on the other, untreated, breast, may be done so that the two breasts match in size and shape.

Fat grafting may be used for revision or “touch-up” treatment to add moderate amounts of volume to the breast and correct any shape abnormalities. Fat is removed from another part of the body using liposuction and processed for injection into the breast where additional volume is needed.

Nipple reconstruction may be the final stage in breast reconstruction. In some cases, mastectomy leaves the nipple in place. When the nipple is removed as part of treatment, it can be recreated by transferring skin from another part of your body or by reshaping the skin of the breast into a nipple. Tattoo ink can be used to create a natural-looking areola (the circular area of darkened skin around the nipple).

Schedule A Consultation

Meet Dr. Michael Cash

At Nashville Plastic Surgery, our mission is to treat you with the utmost respect, help you make an educated decision, and provide you with the finest medical services in a safe and professional environment.

Dr. Cash, our board-certified plastic surgeon, specializes in breast augmentation, tummy tuck, liposuction, and more. Schedule a consultation today to learn more!

Timing of Breast Reconstruction

Breast reconstruction may be done, or started, at the time of the mastectomy (immediate reconstruction), or it may be done after breast cancer treatment has been completed (delayed reconstruction).  The timing of breast reconstruction will be discussed at your consultation and is dependent on several factors including other medical problems, tumor profile, and need for subsequent treatment for the breast cancer.

Planning Your Breast Reconstruction

Your breast reconstruction procedure at Nashville Plastic Surgery starts with a consultation with Dr. Cash. He will examine you, ask questions to learn your medical history and understand your goals for the procedure, listen to your concerns, and answer your questions. 

When he has a full understanding of your medical situation and your wishes, he will describe your options for breast reconstruction and recommend an approach that will give you the best results. He will describe what the procedure entails, its risks and cost, and what you can expect in recovery as you heal from the surgery. 

Dr. Cash’s goal in every procedure is to produce the most natural-looking results with the least discomfort and lowest level of risk for the patient.

Transformative Results Today!

What to Expect in Recovery

Most breast reconstruction patients will need to recover in the hospital for a few days. When you are released to go home, you may continue to experience some discomfort, which you can manage with pain medication. You may also have some swelling and bruising in your breasts and in areas where tissue has been removed, which will gradually resolve as your tissue heals. You will be provided with a surgical bra to control swelling and hold the breast in its new shape.

Dr. Cash will provide you with detailed instructions on how to take care of yourself as you recover, when to see him for follow-up appointments, and how to reach him with any concerns. You’ll need to avoid heavy lifting and strenuous activities for four to six weeks after your surgery. However, you will shower two days after the operation and will be able to raise your arms above your head. 

Schedule Your Nashville Breast Reconstruction Consultation Today

Contact Nashville Plastic Surgery online or by calling (615) 454-2271 to schedule a consultation for breast reconstruction with Dr. Michael Cash. He will examine you, review your medical history, ask questions to understand your goals for the procedure, and give his recommendations for the best and safest approach. Patients in metro Nashville and throughout Middle Tennessee choose Dr. Cash as their cosmetic surgeon because of his ability to create stunning results and for the caring attention he and his staff provide.

Breast Reconstruction FAQs

Health insurance plans that cover mastectomies are required to cover the costs of breast reconstruction. We will discuss the cost of your breast reconstruction once we know what the surgery will involve. We can also help you understand whether any of the costs will be covered by your insurance.

Breast reconstruction does not increase the chances of cancer coming back or the effectiveness of regular cancer screenings. If you have implants, you should let the radiologist know before you have a mammogram, as different procedures may need to be followed to get an accurate scan and protect the implant from damage.

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2201 Murphy Avenue, Suite 301,
Nashville, TN 37203

At Nashville Plastic Surgery, we have a deep understanding of the important role that physical image plays in life, yet we never lose sight of emotional well being. Our approach to plastic and reconstructive surgery integrates these fundamental principles to promote overall health.