After a general surgeon removes a breast tumor and the surrounding breast tissue (mastectomy), a plastic surgeon may reconstruct the breast. A silicone or saline implant may be used. Or in a more complex operation, tissue may be taken from other parts of the woman’s body, such as the abdomen, buttock, or back. Reconstruction may be done at the same time as the mastectomy—a choice that involves being under anesthesia for a longer time—or later—a choice that involves being under anesthesia a second time. Reconstruction of the nipple and surrounding skin is done later, often in a doctor's office. A general anesthetic is not required. In many women, a reconstructed breast looks more natural than one that has been treated with radiation therapy, especially if the tumor was large. If a silicone or saline implant is used and enough skin was left to cover it, the sensation in the skin over the implant is relatively normal. However, neither type of implant feels like breast tissue to the touch. If skin from other parts of the body is used to cover the breast, much of the sensation is lost. However, tissue from other parts of the body feels more like breast tissue than does a silicone or saline implant. Silicone occasionally leaks out of its sack. As a result, an implant can become hard, cause discomfort, and appear less attractive. Also, silicone sometimes enters the bloodstream. Some women are concerned about whether the leaking silicone causes cancer in other parts of the body or rare diseases such as systemic lupus erythematosus (lupus). There is almost no evidence suggesting that silicone leakage has these serious effects, but because it might, the use of silicone implants has decreased, especially among women who have not had breast cancer.