The aim of the procedure is to recreate the natural contour of a woman’s breast, by using artificial breast implants or their own body tissue to make a breast mound and nipple. Your surgeon will discuss which method is best for you, and this usually depends on your general health, the size and shape of your breast and the availability of your own tissues for use in reconstruction. Often, more than one surgical procedure is required.
Frequently, breast reconstruction is possible at the time of your mastectomy surgery. However, in some cases, the reconstruction may be delayed. Again, your surgeon will talk to you about the best time for you to have a breast reconstruction.
A flap is a segment of tissue that is transferred from one part of the body to another with its own blood supply. For breast reconstruction, this usually involves skin, fat and muscle. The most common sites from which these are taken are the abdomen, called a Deep Inferior Epigastric Perforator Flap (DIEP), Transverse Rectus Abdominus Myocutaneous (TRAM) flap, and the back, called a latissimus dorsi flap.
Flap reconstruction is a more involved and a longer operation, than one employing breast implants, and involves scars to another part of the body. Recovery, therefore, does tend to take longer.
A DIEP flap uses the use of an oval piece of skin and fat from your abdomen. The flap is then joined to vessels in the chest to give the flap a new blood supply. This is usually the best form of reconstruction to create a natural-looking and natural-feeling breast, especially in the moderate to large breast size.
In some cases the same tissue in the DIEP above is left on the abdominal muscle (rectus) and tunnelled into the mastectomy defect to recreate the breast.
The latissimus dorsi flap uses some of the skin, fat and muscle from your back to recreate a breast mound. This tissue can be used alone to create a small breast, but for larger breast reconstruction your surgeon may also need to use an implant to match the size of your other breast.
Implant reconstruction surgery is generally a two-stage procedure. It’s good for reconstructing small to moderate-sized breasts, where the natural droop is minimal and the woman is of a thin build.
In the first stage (usually at the time of mastectomy), an expander, or balloon-like device, is placed under the skin and chest muscle. Then, when all the wounds are healed, you will have to visit your specialist’s rooms on a regular basis, usually over several weeks or months, to have the expander gradually inflated with saline to expand the skin and muscle. This is expanded until there is a sufficient-sized pocket to accept an implant to match your other breast.
The second stage is performed generally three months after the expansion is complete. It involves removing the expander and inserting an appropriate shaped and sized implant to match your other breast. The breast implant is made of silicone or filled with saline.
Others are performed directly to a breast implant. Not all cases are suitable and our plastic surgeon will discuss this with you.
All the surgery for the reconstruction of the breast is performed through the mastectomy scars, so no new scars are created.
As we have detailed, there are many ways to recreate your breast, so it is important for your surgeon to discuss with you the timing and type of reconstruction that is most suitable for you.