If you are considering breast reconstruction surgery, there are a few different methods to consider.  The type of breast reconstruction you have is dependent on a number of factors which include personal preference and relevant physical factors related to your illness. Understanding each procedure is important as each surgery will benefit patients in various ways. We have detailed below the different breast reconstruction implant options available to you:

Breast reconstruction with implants involves using silicone or saline implants to create a new breast and can be carried out at the same time as mastectomy surgery or at a later date. Implant reconstruction is good if you do not need radiation therapy as there is a high chance of complication in an implant reconstruction after radiation.

Immediate reconstruction with an implant

Done at the same time as the mastectomy, this surgery takes around three hours so is suitable if you can’t endure longer surgery. If your skin doesn’t need stretching, your surgeon will insert a permanent implant under your chest muscle. If your chest muscle needs to be stretched, tissue expanders will be used which are gradually injected with saline until the breast reaches the desired size. Once the breast shape is the right size the surgeon removes the expander and replaces with a permanent implant. This makes it a two-stage reconstruction and will lengthen the process.

Autologous “flap” reconstruction – this method does not involve the use of silicone or sterile water implants. Instead, your surgeon will use your own tissue to create a new breast. The technique is known as ‘flap reconstruction’ and involves taking skin, fat and sometimes muscle from different areas of the body to create a breast shape.

This procedure is appropriate for women who:

• Completed radiotherapy
• Have a tight mastectomy scar
• Are looking for a more ‘natural’ breast reconstruction result
• Have larger breasts

What is flap breast reconstruction?

As mentioned previously, flap reconstruction involves removing skin, fat, and muscle from certain areas of the body and using them to sculpt a new breast. This can be done at the same time as the mastectomy or at a later date. Taking into account your personal preference and lifestyle, there are a few different breast reconstruction procedures to consider.

Types of flap reconstruction available at The McIndoe Centre include:

Flap reconstruction from the stomach – a DIEP Flap is where tissue from the stomach is taken in such a way that mimics the effects of a tummy tuck. Patients who have this surgery will have a horizontal scar from hip to hip (just like a traditional tummy tuck) and also a scar across the breast. A DIEP is fast becoming the gold standard for breast reconstruction and has the added benefit of preserving all the abdominal muscles. This technique requires microsurgery which is a very advanced method and as such The McIndoe Centre is on the few facilities to offer this.

Flap reconstruction from the buttock – An SGAP/IGAP flap or gluteal perforator hip flap, uses the section of skin and fat from your upper buttocks/hip (“love handles”) to reconstruct the breast. Only skin is used to reconstruct the breast and surgery effectively gives you a buttock lift leaving a scar at the top of your buttocks which is easily concealed by your underwear.

Flap reconstruction from the inner thigh – reconstruction using thigh tissue is called a TUG flap and involves taking a flap of skin, fat, muscle, and blood vessels from the upper thigh The flap is moved up to your chest and using microsurgery your surgeon will reattach the blood vessels of the TUG flap to your chest. This type of reconstruction is good for patients who don’t have enough surplus tissue elsewhere to make new breasts and is also more suitable for women who have smaller breasts in the first place.

Flap reconstruction from the shoulder - this procedure consists of taking the latissimus muscle (the muscle responsible for the twisting action in your back) to the breast area while keeping it attached. This method almost always requires an implant and is considered a muscle-transfer type of flap. If you play racquet sports or are a keen swimmer you may want to consider other options.

Summary of the breast reconstruction implants:

There are several different breast reconstruction implant methods, all of which have been detailed below:

For more information on these procedures, please do not hesitate to get in touch with our team at The McIndoe Centre. If you would like some advice on post-operative breast reconstruction, the NHS has provided an essential handbook for patients.

Am I suitable for breast reconstruction?

There are many factors that impact your suitability for breast reconstruction. You must be at a point in your breast cancer journey where you are strong enough to have surgery. If you are still receiving anti-cancer treatment this will affect the timing and type of reconstruction you have. As with all types of surgery, it is vital that you are fit and well before surgery. Ideal patients must be close to their ideal weight and non-smokers. Procedure-specific eligibility will be fully discussed during your consultation.

Which breast reconstruction method is right for me?

Breast reconstruction is a very personal procedure, and whilst one patient may benefit from breast reconstruction with implants, others may benefit from breast reconstruction with their own tissue. The choice is up to you and your surgeon, you must take into account what will benefit you most emotionally, physically and aesthetically. It is your consultant's duty to go through all the options with you so you can make a fully informed decision.

For more information on how we can help you choose your breast reconstruction procedure, visit our contact page.

This article was written by Rowan Joseph-Lake, in collaboration with Anita Hazari MB BS, MD, FRCS, FRCS (Plast), Consultant Plastic and Reconstructive Surgeon. Miss Hazari performs a range of procedures at The McIndoe Centre specialising in breast surgery (reconstructive and cosmetic).