Heather Karu, M.D., a plastic surgeon at Sanford Health, talks about breast reconstruction surgery options and the process for breast cancer surgery patients. After surgeons insert the tissue expander, patients come in weekly to have fluid added to the expander. Dr. Karu uses a relaxed pace so that patients remain comfortable throughout the process, which is highly important to be able to continue to work and be with your family. The process can be speeded up if a patient desires. Week by week, fluid is added to a small port in the expander until the desired breast size is achieved. The expander is then overfilled a bit toward the end of the process and then there is a waiting period before the second surgery. The second surgery is much easier than the first and involves taking out the expander through part of the mastectomy incision, then doing several shaping changes to the implant space to develop a rounder breast, create a fold under the breast to look more natural and enable the breast to fit better in a bra. The goal of the second surgery is to create as natural appearance as possible to the recreated breast.