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Breast Reconstruction

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy.

Although breast reconstruction can rebuild your breast, the results are highly variable. A reconstructed breast will not have the same sensation and feel as the breast it replaces.

Visible incision lines will always be present on the breast, whether from reconstruction or mastectomy. Certain surgical techniques will leave incision lines at the donor site, commonly located in less exposed areas of the body such as the back, abdomen or buttocks.

A note about symmetry: If only one breast is affected, it alone may be reconstructed. In addition, a breast lift, breast reduction or breast augmentation may be recommended for the opposite breast to improve symmetry of the size and position of both breasts. Please see our sections on Oncoplasty and Reconstruction—Reshaping Your Options for more information.

Autologous Reconstruction

Breasts can be reconstructed by surgically moving a section of skin, fat and muscle from one area of your body to your chest, this is referred to as an Autologous Reconstruction.

In Autologous Reconstruction, tissue is taken from your abdomen, upper back, upper hip or buttocks. Depending on your plastic surgeon’s surgical plan, the tissue flap may be left attached to the blood supply and moved to the breast area through a tunnel under the skin called a Pedicle Flap, or it can be removed completely and reattached to the breast area by a microsurgical technique called a Free Flap.

The advantage of flap surgery is the replacement of chest area tissue. This is an important consideration if:

  • Your chest tissue has been damaged and is not suitable for tissue expansion
  • Extra tissue is needed to recreate a large breast without a breast implant
  • Extra tissue coverage is needed over a breast implant

Flap Reconstruction is a major surgery. It requires a hospital stay and longer recovery time. Flap surgery also creates scars at the site where your flap was taken and additional scars are possible at the site of your reconstructed breast.

It is important to reinforce that tissue flap surgery, particularly the TRAM and DIEP flaps, are major surgeries, more extensive than your mastectomy. They require good general health and strong emotional motivation.

If you are very overweight, smoke, have had previous surgery in the area the flap would be taken, or have any circulatory problems, you may not be a good candidate for a tissue flap procedure. If you are very thin, you may not have enough tissue in your abdomen or back to create a breast using this method.

The Three Most Frequent Types of Flap Surgery

TRAM

Transverse Rectus Abdominus Myocutaneous Flap

TRAM surgery involves moving fat, skin and muscle from the lower abdomen (C) to create a new breast mound (A).

The surgery is approximately 3 to 6 hours long, requires a hospital stay of 2 to 5 days and 6 to 8 weeks to resume normal daily activity.

Some women refer to this as the “tummy tuck” procedure, because a flatter stomach is often part of your result. Obtaining the flap for your new breast will leave a scar on your abdomen.

DIEP
Deep Inferior Epigastric Perforator

In simple terms, DIEP is a TRAM surgery without using the muscle from your abdomen; just the skin and the fat. This procedure uses microsurgery to reattach the blood supply to the flap once it is placed on your chest. And like a TRAM flap, DIEP surgery is approximately 3 to 6 hours, requires a hospital stay of 2 to 5 days and 6 to 8 weeks to resume normal activity. The scarring concerns are the same as with the TRAM procedure.

Latissimus Dorsi Flap

Sometimes called the Latiss Flap, this procedure involves taking the latissimus muscle from your back and rotating it around to your front to create, or help create a breast mound. Sometimes an implant is used when the muscle isn’t large enough to produce the desired size. This will leave a scar on your back.

The surgery is approximately 2 to 4 hours, requires a hospital stay of about 2 to 3 days and 2 to 3 weeks before you can resume normal activity.