Will Breast Density Limit My Plastic Surgery Options?

Getting good news about breast density and plastic surgery options

The last time you got your mammogram results, did you notice a little note about your breast density? If you are like 40 percent of women, it might have said something like, “Your breasts are heterogeneously dense, which may obscure small masses and may put you at greater risk of developing breast cancer in the future.” Though this may sound a bit scary, it’s actually a normal reading.

Normal breast density exists on a spectrum from not dense at all to extremely dense. Knowing this information is important; it helps women and their doctors decide which breast screening methods are best, and how often they should get them. According to the American Cancer Society, whether a woman has dense breasts or not, regular screenings (mammograms in particular) are still the best way to find cancer early.

Because of the relationship between breast density and cancer risk, it is now the law in many states that breast density information be conveyed to each woman who has a mammogram. You may have seen talk of this newer legislation on the news.

What this means is that more women than ever before know that breast density matters, and many can tell you just how dense their own breasts are. Knowing this has also left some women wondering if their breast density will affect their options when it comes to cosmetic breast surgery.

To help answer this question, it will help if we first explain what doctors mean when they talk about breast density.

Breast density is a radiologic (mammogram) finding that has nothing to do with how breasts look or feel from the outside. The classification of density has to do with the ratio of fat (not a dense tissue) to everything else that makes up the breast, including glandular and fibrous tissue. On a mammogram, the fat shows up dark and the other stuff shows up white. The more white seen on a mammogram, the more dense the breast classification. The breast density classifications that may be assigned are – from least dense to most dense – the following:

  1. Fatty
  2. Scattered Fibroglandular
  3. Heterogeneously Dense
  4. Extremely Dense

Only about 10 percent of women are categorized as having extremely dense breast tissue. You can learn more about these breast density types, and see images too, at the American Cancer Society.

Here at North Texas Plastic and Reconstructive Surgery, Dr. Slack performs a wide range of cosmetic breast procedures including breast implants, liposuction, breast lifts, and breast reductions. In some cases, he may perform a combination of one or more of these procedures, depending on the goals of the patient. Here is how breast density may come into play with each of these procedures:


Breast implants are placed underneath the breast tissue not within in. This means that the breast tissue itself, no matter how dense, sits on top of the implant and therefore has little bearing on whether a breast implant is possible.


Liposuction alone is sometimes an option for women who are looking for a mild reduction in breast size. It is possible that a woman with extremely dense breasts, which means they have a lower ratio of fat to other tissue, may have a limit as to how much fat can be successfully removed using this method.

Breast Reduction or Lift

A breast reduction or lift sometimes includes liposuction, and the limitation just mentioned may come in to play to some degree. However, because these procedures also include an open surgical component, the goal of the reduction usually isn’t limited by breast density.

Here is the big takeaway: None of these procedures are off limits to a woman simply because she has higher breast density.

There are many factors that will limit a person’s plastic surgery options, including poor health, weight instability, and a bad smoking habit, but breast density usually isn’t one of them. That said, every person who walks into our clinic has their own unique anatomical identity, and that includes breast density. Dr. Slack takes all of this (and more) into consideration when advising each patient and planning their surgery.

If you have more questions about breast density and which breast procedures might be right for you, call our office today and schedule a consultation with Dr. Slack.

Timing Your Breast Reconstruction After Mastectomy

Breast reconstruction isn’t for everyone. Tig Notaro, for example.

After her double mastectomy without reconstruction, the dry-witted comedian embraced her new body and performed topless (for a full 20 minutes!) in her 2015 HBO special Boyish Girl Interrupted. If you aren’t as willing to accept a new life without breasts, reconstruction may be an easy choice for you. Even if you aren’t 100 percent sure whether you will want a breast reconstruction, do your due diligence now because timing matters if you want to achieve optimal results.

Here’s what the American Cancer Society has to say about that:

“If you are thinking about having reconstructive surgery, it is best to talk about it with your surgeon and a plastic surgeon experienced in breast reconstruction before you have surgery to remove the tumor or breast. This lets the surgical teams plan the best treatment for you, even if you decide to wait and have reconstructive surgery later.”

Breast reconstruction is most often performed at the same time as mastectomy (immediate reconstruction), but it can also be done years later (delayed reconstruction). In other words, though you shouldn’t wait to get informed, you don’t have to decide whether to have the surgery right away. With everything you have to think about before a mastectomy, it can be overwhelming to have to make a decision about reconstruction too. Your doctors may also recommend you wait if you are continuing with radiation treatment.

Here are some other reasons to delay reconstruction.

You are a smoker

Cigarettes and other tobacco products contain hundreds of toxic chemicals, including nicotine, hydrogen cyanide, and carbon monoxide. They leave your body with an overall shortage of oxygen and make it harder to heal. Smokers are more likely to suffer from complications, like an infection or blood clot, during or after surgery.

While claims have been made that e-cigarettes are a healthier alternative, this does not make them safe. Toxic metals like lead, chromium, manganese and nickel have been detected in their vapor. Read more about vaping and plastic surgery in this post.

Most plastic surgeons will require that you quit smoking at least four weeks before surgery.

You have other health problems

Cancer may not be the only health problem you are dealing with. Conditions such as obesity, diabetes, heart disease, stroke, high blood pressure, sleep apnea, or other breathing problems can impair your body’s ability to withstand the stresses of another surgery.

Your plastic surgeon will likely require that conditions like these be managed and well under control before undergoing breast reconstruction.

You haven’t found the right plastic surgeon

Your oncologist or surgeon will likely be able to refer you to a qualified plastic surgeon before your mastectomy. Take the opportunity to meet with them as soon as possible. You want to do your homework to make sure the surgeon is right for you. Your plastic surgeon should be board certified and have hospital privileges at a reputable facility you have access to.

Breast reconstruction is complicated and no two surgeries will be the same. You will need someone (like Dr. Slack) who has specific training and experience in breast reconstruction surgery and is able to discuss the options available to you.

Whether and when to have breast reconstruction after mastectomy is a very personal decision. One that you need to make with your healthcare team, including a plastic surgeon. Maybe, like Tig and many other women, you will decide to go flat, or maybe reconstruction is a no brainer for you. As long as you are informed, there is no wrong choice. You do you—shirt off, or on, or somewhere in between.

If you have any questions or want to learn more about breast reconstruction, contact our office today

New Research Delivers Good News for Breast Cancer Survivors

One thing you can say about breast cancer survivors: they have fortitude. They don’t give up on life, and then after they have beaten cancer, they don’t give up on getting back their quality of life. To retake ownership of their own bodies, their sexuality, and their self-esteem, many women choose breast reconstruction after mastectomy. There were over 100,000 procedures performed in 2016 alone.

Breast reconstruction involves surgery to recreate a breast mound and (optionally) a new nipple. Because all women and all cases of cancer are unique, no two surgeries are the same. However, there are two main ways a breast mound can be reconstructed: using implants or using tissue from another part of the patient’s body (autologous reconstruction). Sometimes a combination of the two is also done.

  • Breast implants can be filled with silicone gel, saline, or a combination of the two.
  • Autologous reconstruction uses tissue usually taken from the patient’s thigh, back, buttocks or abdomen.

There is great debate over which of the above two methods is best. Autologous reconstruction may result in softer more natural looking breasts but a second surgical site is needed for harvesting the graft tissue. Implants may allow for larger breasts, but they may not look and feel as much like a woman’s natural breasts. The choice is personal and should be made with the help of a qualified plastic surgeon experienced with breast reconstruction.

Both options have been studied extensively, are safe, and result in high patient satisfaction scores and improved quality of life. Even so, a small percentage of women who have implant-based breast reconstruction later decide to have their implants removed and change to autologous reconstruction. This may be due to personal choice or complications.

Based on experience, many plastic surgeons will tell you that patients do well after this kind of second reconstruction. However, because it is not so common, there has been little research on how well these patients do statistically as a group. That is until now.

Researchers at Memorial Sloan Kettering Cancer Center collected and analyzed data on women treated at their center between 1997 and 2017. Their results were published this month (February, 2019) in the journal Plastic and Reconstructive Surgery.

The research team found just under 140 women who had undergone autologous reconstruction after what was considered a “failed implant-based reconstruction.” They defined the implant procedure as “failed” if the implant became scarred down and resulted in discomfort and a change in breast appearance.

On average, the women included in the study had the second reconstruction three and a half years after the first one. Analysis of the medical records and patient surveys showed a good success rate, few complications, and “significantly improved patient satisfaction and quality of life.”

This is good news for the few women who experience complications with breast implants following mastectomy. For them, an autologous reconstruction may be a very good option, and these women deserve all the options we can give them.


Dr. Charles Slack completed a plastic surgery fellowship, followed by an additional surgical fellowship in Cosmetic and Reconstructive Surgery of the Breast at Georgetown University.
If you have been diagnosed with breast cancer and are considering reconstruction, it is not too early to talk to an experienced plastic surgeon. Contact our office to schedule an appointment with Dr. Slack today.