Types of breast reconstruction

There are many different ways to reconstruct a breast reconstruction after mastectomy or lumpectomy. Not all surgeons practice all techniques and some options may only suit some people.

Broadly speaking, breast reconstruction can be one of three types:

Reconstruction using an artificial implant

Reconstruction using tissue from your own body

Reconstruction using a combination of your tissue and an implant

In addition, the reconstruction can be either immediate (at the same time as the mastectomy) or delayed (months or even years later).

The method that’s best for you will depend on a number of factors, including whether or not you want immediate results, type of breast deformity, your body type, whether or not you plan on getting pregnant, the characteristics and staging of your cancer, your own preference and the experience of the surgeons. Your healthcare team can talk to you about the options that are best for you.

RECONSTRUCTION USING A BREAST IMPLANT

reconstruction-with-breast-implant

An implant filled with silicone gel is placed under the skin and muscle that covers your chest to create a breast shape. The initial step in this process is to insert a tissue expander in order to stretch healthy skin to provide coverage for the implant. The tissue-expander is then slowly filled through an internal valve over the course of 4 to 6 months. A second surgical procedure may then be needed to replace the expander if it’s not designed as a permanent implant.

RECONSTRUCTION USING YOUR OWN TISSUE

Known as “flap” procedures, skin, fat and sometimes muscle are taken from another part of your body to make a new breast. This type of operation is more complex than using an implant alone. There are several types of flap procedures:

Tram Flap

A TRAM flap, the most common type of flap procedure, uses muscle, fat and skin from your abdomen to reconstruct the breast. The flap may either remain attached to the original blood supply and be tunneled up through the chest wall, or be completely detached, and formed into a breast mound.

Diep Flap

DIEP  flaps are similar to TRAM flaps, but don’t use muscle from your abdomen, only fat and skin.

Latissimus Dorsi

A Latissimus Dorsi (LD) flap uses muscle, fat and skin from your back tunneled to the mastectomy site and remains attached to its donor site, leaving blood supply intact.

A flap can occasionally reconstruct a complete breast mound, but usually it serves to provide the muscle and tissue necessary to cover and support a breast implant.

A COMBINATION OF AN IMPLANT AND YOUR OWN TISSUE

combination-of-techniques

A breast shape is created using both an implant as well as skin, fat and sometimes muscle taken from another part of your body using one of the above flap techniques.

WHICH IS THE MOST SUITABLE FOR ME?

Which type of reconstruction is most suitable for you depends on:

How much of your breast tissue has been removed

How healthy the tissue is on your breast and on other areas of your body that may be used (donor sites)

Whether you’ve had radiotherapy to the breast area or chest wall

The shape and size of your breasts

Your preference

Your general health and body build

THE TABLE BELOW COMPARES THE BASIC TYPES OF BREAST RECONSTRUCTION.

BREAST IMPLANTS

OWN TISSUE

COMPARED TO NATURAL BREAST

Looks and feels less like a natural breast (silicone implants look and feel more natural than saline implants)

Looks and feels more like a natural breast

LOSS OF SENSATION

Will likely lose some sensation in the breast

Will likely lose some sensation in the breast and tissue donor site

SURGERY

Less extensive
Time in surgery is shorter

More extensive
Time in surgery is longer

HOSPITAL STAY

Needed for the first procedure
Follow-up procedures can be on an outpatient basis

Needed for the procedure, with longer stay than with implants

FOLLOW-UP PROCEDURES

Implants will likely need to be replaced during lifetime.

Flaps won’t need to be replaced during lifetime, but if there are complications, some procedures cannot be repeated.

RECOVERY

2 to 3 weeks
Fewer scars

3 to 6 weeks
More scars

RISK OF COMPLICATIONS

Some risk of surgical complications

Some risk of surgical complications (certain procedures have more risks than others)