Breast reconstruction is the term used to re-build one or both breasts following a mastectomy or breast conserving surgery. It can be done at the same time as the mastectomy (immediate reconstruction) or as a separate procedure at a later date (delayed reconstruction). There are two main types of reconstruction – autologous tissue reconstruction and prosthetic reconstruction.
Autologous tissue reconstruction: A piece of tissue containing skin, fat, blood vessels, and sometimes muscle is used to rebuild the breast. This piece of tissue is called a ‘flap’ and can be taken from different parts of the patient’s body:
TRAM flap: Tissue (and muscle) is taken from the lower abdomen. This is the most common type of tissue used in breast reconstruction.
DIEP flap: Tissue taken from the abdomen, as in a TRAM flap, but only contains skin and fat.
Latissimus dorsi flap: Tissue that is taken from the middle and side of the back.
Prosthetic Reconstruction: Implants (expanders) are inserted underneath the skin and chest muscle that remain after a mastectomy, usually as part of a two-stage procedure.
In the first stage the surgeon places an expander under the skin and chest muscle. Post surgery the expanders are slowly filled with a saline solution, during scheduled visits, to gradually stretch the breast skin in preparation for the second stage. The second stage of the procedure sees the expanders removed and replaced with permanent implants.
An optional stage of breast reconstruction involves recreating a nipple on the reconstructed breast. After the chest heals from reconstruction surgery a surgeon can reconstruct the nipple and areola by cutting and moving small pieces of skin from the reconstructed breast on the nipple site and shaping them into a new nipple, which may later be tattooed to reconstruct the areola. This procedure is generally not necessary in a nipple-sparing mastectomy.