The surgery that comes after. Not the end.
Breast reconstruction is the surgical rebuilding of a breast (or both breasts) after mastectomy for cancer or, less commonly, after other procedures that have removed breast tissue. It is different from every other procedure on this site — not cosmetic in origin, though cosmetic in technique; not elective in the usual sense, though undertaken by choice; performed for patients who have already faced the hardest part of their medical journey and are now ready for the surgical closure that comes after.
At NCSS, breast reconstruction is anchored by Dr. Karen Leong, whose training and clinical focus include substantial post-mastectomy reconstruction work. She brings her cases to NCSS when the specific facility environment fits: physician anesthesia, dedicated nurse, endocrinology on call, and the perioperative depth our AAAHC-accredited operating rooms provide. Other affiliated surgeons at NCSS also perform reconstruction where their scope fits.
Insurance coverage for breast reconstruction is federally mandated under the Women's Health and Cancer Rights Act (WHCRA) of 1998. Any insurance plan that covers mastectomy must cover reconstruction of the affected breast, reconstruction of the other breast for symmetry, prostheses, and treatment of complications of mastectomy or reconstruction. Our clinical team helps you navigate coverage details specific to your carrier.
Federal Coverage Mandate
Under the Women's Health and Cancer Rights Act (WHCRA) of 1998, any insurance plan that covers mastectomy must cover reconstruction — including the opposite breast for symmetry, prostheses, and treatment of complications. Our clinical team helps you navigate coverage details specific to your carrier.
Who this procedure is designed for.
Reconstruction is appropriate at many stages — immediately after mastectomy, years later, or as revision of prior work performed elsewhere.
Post-mastectomy after cancer treatment
The most common presentation. Reconstruction can be immediate (at the time of mastectomy, coordinated with the breast surgeon) or delayed (weeks, months, or years after mastectomy). Both timings have advantages.
After completion of adjuvant treatment
Patients who have finished chemotherapy and/or radiation and are ready for reconstruction. Radiation particularly affects reconstruction planning — tissue changes from radiation influence which reconstruction approach fits best.
Prophylactic mastectomy patients
Women who have chosen mastectomy for genetic risk (BRCA, others) or strong family history. Reconstruction is typically performed at the same time as mastectomy in these cases.
Contralateral symmetry procedures
WHCRA covers reconstruction of the opposite breast for symmetry — lift, augmentation, or reduction as needed to match the reconstructed side. This is often part of the overall plan.
Revision of prior reconstruction
Patients whose prior reconstruction (performed elsewhere) has developed problems — capsular contracture, implant issues, aesthetic concerns — and who want revision.
Realistic expectations about the process
Reconstruction is often a multi-stage process. Initial reconstruction, nipple reconstruction (weeks to months later), tattooing of the nipple-areola complex, and refinement procedures may all be part of the complete plan.
Emotional readiness for the process
Reconstruction happens after significant medical treatment. There is no 'right' time to begin — some patients want reconstruction immediately, others need years of separation from their cancer treatment before they are ready. Both are legitimate.
Every scheduled surgical patient is offered a free Rest-Assure pre-operative consultation with Dr. Rand Scott personally — medical history, medication planning, and discharge coordination before surgery day.
Three stages, one procedure.
Breast reconstruction encompasses several fundamentally different approaches, each with specific candidacy and tradeoffs:
Implant-based reconstruction — two-stage
The most common approach. Stage 1: a tissue expander is placed at the time of mastectomy (or later). The expander is gradually filled over weeks in office to stretch the tissue. Stage 2: the expander is replaced with a permanent implant (silicone or saline) in a second surgical session.
Implant-based reconstruction — direct-to-implant
Single-stage placement of the permanent implant at the time of mastectomy, without an expander phase. Appropriate for select patients where breast skin quality allows.
Autologous reconstruction — DIEP flap
Uses the patient's own abdominal tissue (skin and fat, but not muscle) to build a new breast. Requires substantial surgery and microvascular expertise; produces a permanent, natural-feeling breast without an implant. Not all affiliated surgeons perform DIEP flaps; those who do work closely with microvascular colleagues.
Autologous reconstruction — TRAM, latissimus flaps
Alternative flap-based reconstructions using different tissue sources. Appropriate in specific anatomic circumstances.
Fat grafting adjuncts
Fat transfer plays an important role in modern reconstruction — used to improve contour, camouflage implant edges, and refine the reconstructed breast. Often used in staged sessions after the primary reconstruction.
Nipple reconstruction and tattooing
Reconstruction of the nipple-areola complex is typically a later-stage refinement. Various surgical techniques for the nipple mound; three-dimensional tattooing for pigmentation, often producing remarkably realistic results.
Contralateral symmetry procedures
Lift, augmentation, or reduction of the opposite breast to match the reconstructed side. Covered by insurance under WHCRA.
For patients whose reconstruction plan includes complex microvascular work, appropriate facility and surgical team coordination is arranged.
Two sites. One recovery.
Reconstruction recovery varies dramatically by approach. General expectations for the major categories:
Discharged the day of surgery. Restricted arm movement. Return to desk work at 2–3 weeks. Progressive expansion in office begins 2–4 weeks post-op, continues over 2–4 months until target size is reached.
Shorter recovery than stage 1. Return to work at 5–10 days. Return to full exercise at 4–6 weeks.
Similar to breast augmentation but with the added recovery from mastectomy. Return to work at 2–3 weeks; return to exercise at 4–6 weeks.
Substantial recovery involving both the breast and the abdominal donor site. Inpatient stay of 3–5 days after surgery. Return to desk work at 4–6 weeks. Full recovery at 6–12 weeks.
Shorter recovery than the primary reconstruction. Return to normal activity at 1–2 weeks.
Outpatient procedure with minimal recovery. Return to activity within days.
Implant-based reconstruction requires eventual implant exchange (typically 10–15 years). Autologous reconstruction is permanent. Aging affects reconstructed breasts differently than native breasts — discussed during consultation and follow-up.
Every Breast Reconstruction patient at NCSS is covered by our Rest-Assure program: physician anesthesia on the day of surgery, one nurse from arrival through discharge, and post-operative direct access to your surgeon — not an answering service.
Dr. Leong anchors the program. Others contribute where it fits.
Breast reconstruction at NCSS is anchored by Dr. Leong, whose substantial focus in this area brings selective cases to our facility when the specific environment fits.
Dr. Leong
Reconstruction · Substantial FocusBrown-trained female plastic surgeon; fellowship under Daniel Mills; post-mastectomy reconstruction is a substantial part of her practice.
View surgeon →Dr. Bernett
Female Surgeon · Full ContinuumUC Irvine trained; reconstruction as part of a full aesthetic and reconstructive practice; fluent Spanish and Italian.
View surgeon →The right starting point is a conversation.
Every consultation at NCSS begins with time — time to understand your goals, your health history, and which of our affiliated surgeons is the right fit for your specific situation.
Call (949) 644-8182Monday–Thursday, 8am–3pm · Friday by appointment only.
Related procedures.
Fat Transfer to Breast
Fat grafting plays an important role in modern reconstruction — refining contour and camouflaging implant edges in staged sessions.
Learn more →Breast Augmentation
Contralateral symmetry procedure — augmentation of the opposite breast to match the reconstructed side, covered under WHCRA.
Learn more →Breast Reduction
Contralateral symmetry procedure — reduction of the opposite breast to match the reconstructed side, covered under WHCRA.
Learn more →