MEDICAL ANIMATION TRANSCRIPT: Breast reconstruction helps restore the appearance of the breast after a mastectomy. It may be performed at the time of mastectomy or some time later. You and your surgeon will choose which type of reconstructive surgery is best for you. Your choices will generally include either a synthetic implant or one of two procedures using your own tissue to rebuild your breast-- a latissimus dorsi muscle flap or an abdominal muscle flap, which is also called a TRAM flap. Before the procedure, an intravenous line will be started and you may be given an oral sedative to help you relax. Breast reconstructions are done under general anesthesia. You will be asleep for the duration of the surgery, and a breathing tube will be inserted through your mouth and into your throat to help you breathe during the operation. For a latissimus dorsi muscle flap, your surgeon will make an incision in your upper back, separate a section of tissue, and rotate the flap into position at the site of the mastectomy. A transverse rectus abdominis myocutaneous flap, or TRAM flap, begins with your surgeon making an incision in the skin of the chest. Next, he or she will make an elliptical incision in the skin, fat, and muscle of your abdominal wall or, if there's not enough tissue in the abdomen, in your lower back. Next, the surgeon will slide the tissue beneath your skin to the mastectomy site to form a breast mound. Great care will be taken to preserve the blood supply to the reconstructed mound. Finally, your surgeon will close the original wound on your back or abdomen with sutures. The procedure for tissue flaps is similar whether performed immediately or sometime after the mastectomy. The procedure for synthetic implants, however, depends on the timing of the reconstruction. If you choose to have the implant at the time of your mastectomy, your surgeon will insert it immediately after removing your breast tissue and close the wound with sutures. If you choose to have the implant surgery later, your skin may need to be stretched before the reconstruction can occur. In this case, your surgeon will reopen the incision at your mastectomy site and insert a balloon-like tissue expander. Over a period of weeks, your surgeon will cause the chest wall and skin to stretch by regularly injecting salt water into the tissue expander. During a second operation, your surgeon will make another incision, remove the tissue expander, insert a permanent synthetic implant, and close the wound with sutures. After the surgery, your breathing tube will be removed, and you will be taken to the post-surgical recovery area for monitoring. Breast reconstructions are usually inpatient procedures, and most patients remain in the hospital for one to five days after surgery. Once your breast mound is complete, you may decide to have your nipple and areola reconstructed. This is a relatively easy procedure and can usually be done in your doctor's office in 30 to 60 minutes. There are different types of nipple reconstructions, but one common type involves removing tissue from your inner thigh or ear to create a small, nipple-like mound, which may be tattooed to better resemble a natural nipple and areola. This replacement nipple is secured to the central area of the reconstructed breast.