You have many options to consider when choosing a type of immediate or delayed breast reconstruction. Make an appointment with a plastic surgeon who can help you sort through the types of breast reconstruction that will best fit you. A plastic surgeon can offer to show you photos of complete reconstructions, so you can see results of reconstructive surgery. Talk to other breast cancer survivors who chose reconstruction, and ask about their experiences. Each type of breast reconstruction comes with advantages and disadvantages as well as risks.
Breast Implants for Breast Reconstruction
Photo © Linda Bartlett, National Cancer Institute
Implants are used for more than breast augmentation; they are also used for breast reconstruction. In fact, about half of all breast reconstructions are done with implants. These are available in saline and silicone, and come in a variety of shapes, sizes, and textures.
Autologous reconstruction uses your own tissue to create a new breast. You are the donor and the recipient of the tissue, so there's little worry about tissue rejection. Your own skin, fat, and sometimes muscle can be moved from your back, tummy, or buttock, and used to create a breast mound. There are several techniques for autologous breast reconstruction.
Muscle and Skin Breast Reconstruction Types
Illustration © National Cancer Institute
Both of these methods take muscle and skin from one part of your body, and tunnel it into your mastectomy area, to create a new breast. Each type of surgery will leave two scars – from the donor site and at the mastectomy
- TRAM Flap (transverse rectus abdominus myocutaneous) uses a muscle in your abdomen to supply blood to your new breast skin.
- Latissimus Dorsi (lat flap) uses a muscle in your upper back to provide blood supply and skin for a new breast.
Skin and Tummy Fat Microsurgery
Illustration © Pam Stephan
These two methods use only tummy fat, skin and specific blood vessels to provide circulation and volume for your new breast. Because reconnecting blood vessels is delicate work, microsurgery is used to ensure that the tissue will survive in its new location. You will have a tummy tuck as well as a new breast from these procedures.
- DIEP Flap (deep inferior epigastric artery) uses an artery in your upper tummy area to supply blood to the skin and fat that will create your reconstructed breast.
- SIEA Flap (superficial inferior epigastric artery) uses an artery in your lower tummy area to supply blood to the skin and fat to construct your new breast.
Skin and Buttock Fat Microsurgery
Illustration © Pam Stephan
These two methods use only buttock fat, skin and specific blood vessels to provide circulation and volume for your breast. No muscle will need to be moved. Microsurgery is used to reconnect blood vessels and ensure that the tissue will survive in its new location. You will have a buttock lift as well as a new breast.
- IGAP Flap (inferior gluteal artery perforator) uses fat and skin from your lower buttock to create a new breast mound after a mastectomy. None of your gluteal muscle will be cut or moved for an IGAP reconstruction.
- SGAP Flap (superior gluteal artery perforator) uses fat and skin from your upper buttock to create a new breast mound after a mastectomy. No gluteal muscle will be cut or moved for an SGAP reconstruction.
Lumpectomy Repair or Reconstruction
Illustration © Pam Stephan
All methods of breast conservation surgery will leave some asymmetry and imperfections. If you receive radiation, you may find that your skin may shrink and harden, further changing the shape of your breast. Many options are available for repair of these defects and restoration of symmetry.
- Cell Enhanced Breast Reconstruction (fat graft) uses your own fat and stem cells to repair divots and dimples left by a lumpectomy.
- DIEP, SIEA, and TRAM flaps can be modified for lumpectomy repair.
- Latissimus Dorsi mini-flap -- this uses less skin and muscle to provide repair for a breast that is misshapen after cancer surgery.
- AlloDerm (acellular dermis grafts) is donated human skin tissue that can be used as a graft to supplement your own tissue.
All of these breast reconstruction methods will result in a breast mound with a smooth curved surface, unless your nipple and areola are spared. If you need a new nipple and areola complex, there are techniques for nipple reconstruction, and tattooing for a new areola. Nipple reconstruction is considered the finishing touch of breast reconstruction. Talk to your plastic surgeon about which method will work best, and be most durable for you.
- C-V Flap
- Fleur-de-lis Flap
- Skate Flap
- Vulvar or Thigh Skin Flap
- Wrap-around Flap
Have Well-Informed Expectations Before ReconstructionA reconstructed breast will not have the same sensation or texture as your natural breast. Any breast reconstruction type may result in a new breast shape that looks good clothed or unclothed, but be prepared – it won't be just like a new breast. However, most women who choose breast reconstruction report that their body image and self-esteem improves when their breast reconstruction is completed. You were designed to be symmetrical, and with breast reconstruction, you can regain your symmetry.