Breast Reconstruction overview
Great advances in reconstruction techniques now allowed some excellent outcomes with breast reconstruction, which can be performed at the time of mastectomy (called primary or immediate reconstruction) or at a later date (secondary or delayed reconstruction). The choice of when to have reconstruction will be driven by patient choice along with advice from your surgeon and breast care nurse. When patients are known to need other treatments, especially radiotherapy, it ‘may’ be considered better to delay reconstruction. Nipple reconstruction can be performed at the time of reconstruction or usually later.
Types of breast reconstruction
Reconstruction can be performed using breast implants alone, only using your own body tissue (called autologous reconstruction) or a combination of both.
Implant based reconstruction is the most common type reconstruction, especially for immediate reconstruction. It avoids scars elsewhere on the body and is a shorter operation with a quicker recovery. It does usually require two operations. The first operation to place a stretching device, called a tissue expander followed by injections to inflate the device to the required size. After 3-6 months this is swapped for a silicone implant. This technique can produce a pleasing breast shape, but with little natural droop to the breast. Therefore, it is less good at matching a natural breast with droop, particularly as the years pass by when further surgery may become needed. Implant reconstruction is generally avoided in patients treated with radiotherapy as it works less well.
Using your own tissue is usually from the tummy (TRAM or DIEP flap) or from the back (Latissimus Dorsi flap). These bigger operations do leave scars in these ‘donor site’ areas. They take longer to perform and to recover from. The main advantages are results with a more natural feel and a breast that changes with the patient over time. The breast can gain and loose weight and ‘age’ with the patient and are often better at matching the opposite breast over time. They remove long term risks of implant reconstruction such as hardening or distortion over time. However, they have more complications in the initial period compared to implants. Patients need to have enough fat and skin on the back or tummy to have this operation. The tummy operation can have the advantage of a flatter tummy.
When the back operation (Latissimus Dorsi flap) has enough skin and muscle to perform the operation but not enough volume an implant can be added. The main advantage of this over normal implant reconstruction is it is a one-stage operation and allows a more natural breast shape. It is usually used in immediate reconstruction or occasionally in secondary reconstruction when TRAM/DIEP flaps are not available.
