When a breast has been removed because of cancer (mastectomy) it is possible, in most cases, to reconstruct a breast similar to the natural one. Often, a reconstruction can be done at the same time as the mastectomy (immediate reconstruction), but sometimes it is necessary to postpone the reconstruction until all cancer treatments are completed i.e. after chemotherapy and radiotherapy (secondary reconstruction).

There are 3 common methods of breast reconstruction

  • tissue expansion and implant
  • LD flap from the back, with or without an implant
  • TRAM flap from the lower abdomen (no implant required)

There are many factors to consider to plan the best and safest choice of technique for each woman.

Sometimes, surgery to the other breast is required to achieve a good symmetrical result e.g. reduction, lift or augmentation with an implant.

Expansion - implant method : this is a 2 stage technique. At the first operation the expander is placed beneath the skin of the breast, and under the muscle behind the breast. After 2 -3 weeks healing time, injections of saline are added to the expander to restore the breast shape and size. At the second operation, the expander is replaced with a breast shaped silicone gel implant.

LD flap from the back : this method moves muscle, skin and fat from the back to replace tissue removed from the breast. Sometimes there will be sufficient tissue to make a small breast without an implant as well. More often, an implant is required to give enough volume. Usually the surgery is done in 2 stages with an expander being placed under the LD flap initially. After a period of expansion, the expander is replaced with an implant.

TRAM flap from the abdomen : this operation moves fat and skin from the lower abdomen to make the breast. This method can be used where there is sufficient spare tissue in the abdomen : no implant is required. It is my practice to perform a preliminary "delay" operation 1 week before the reconstruction to prepare the tissue for transfer. The "delay" procedure improves the blood supply to the tissues and reduces complications.

Congenital breast anomalies, such as tuberous breast, may require use of these techniques.

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