Understanding Breast Reconstruction Surgery

Understanding Breast Reconstruction Surgery

Understanding Breast Reconstruction Surgery: Which Technique is Best Fit For You?

If you’ve undergone a mastectomy as part of your breast cancer treatment, you will probably want to undergo breast reconstruction surgery. This cosmetic procedure reconstructs the breasts, with the goal being the creation of a natural looking feminine chest.

Whether you’ve undergone a segmental or a full mastectomy, you might want to reconstruct your breasts to get a sense of normalcy back and feel more confident in your own body.

Breast reconstruction surgery is quite common nowadays, and is considered a normal part of breast cancer treatment. It allows patients to fully recover from their battle with cancer, not only physically, but mentally and emotionally as well.

Types of Breast Reconstruction Surgery

There are three different types of breast reconstruction surgery:

?Implant-based reconstruction.

?Autologous tissue reconstruction.

?A combined technique.

To choose which option is best for you, you should consult with your surgeon, and discuss the history of your illness. Your surgeon will take the following into consideration when advising you on the type of surgery to go with:

?The extent of your breast cancer surgery (partial mastectomy or full mastectomy).

?The natural size of your breasts.

?The desired size of reconstructed breasts.

?The size and severity of your cancer.

?The type of treatment you are receiving for your cancer.

?Your body type.

?The amount of excess fat and excess tissue available for harvesting from other parts of your body.

Your overall health, lifestyle and habits, as well as the desired recovery time and your openness to different levels of invasiveness will all be taken into consideration when it comes to choosing the best type of surgery for you.

In order to be able to make an educated decision about the type of surgery you want, it’s important to be informed and understand the differences between the three available procedures and their implications.

Implant-Based Reconstruction

As the name suggests, implant-based reconstruction surgery uses implants for the purposes of rebuilding the breasts. The implant, which can either be saline or silicone, is placed under the pectoral chest muscle in order the give the breast a full and natural shape.

Types of Breast Implants

Breast implants vary in shape, size, and filler type, and can be either tear shaped or round, depending on the natural shape of your breasts. Implants are made out of rubberized silicone and can be filled either with saline (sterile salt water) or silicone gel.

Silicone gel is more viscous than saline, and the main difference between the two is the texture of the reconstructed breast. Silicone implants are considered to provide a more natural look and feel to the breast, but saline implants have the advantage of being postoperatively adjustable; this means that adjustments to the amount of fluid, size and shape can be made after the initial surgery as a response to the way the breasts have adjusted to the rest of the body.

Approaches to Breast Implant Surgery

In order to insert the breast implant into the desired position, the surgeon has to create a pocket in the breasts. There are two techniques that can be used to achieve this:

?Tissue expansion.

?One-step reconstruction.

Tissue expansion

This is a technique used when the skin and the tissues in the chest are too flat or too tight for the surgeon to be able to insert the implant, so the space needs to be made larger. This is achieved with the placement of an expander implant under the muscles in the chest.

An expander implant is a small valve, much like a balloon, usually placed in the breast already during the breast removal surgery. The valve is filled up with saline through the use of a needle, and this process is carried out slowly and gradually over time. The saline is injected once weekly for up to three months, until the skin is stretched enough to be able to fit a breast implant of the desired size.

When an adequately big pocket is made, another surgery is carried out during which the surgeon removes the expander implant and replaces it with the final, permanent implant.

One-step reconstruction

This is a new technique which uses acellular dermal matrix (donated human skin tissue with removed cells). The pocket for the implant is created by stitching the acellular dermal matrix to the breast tissue, and over time it grows into healthy breast tissue.

Autologous Tissue Reconstruction

Autologous tissue reconstruction, also known as “the flap”, is a breast reconstruction technique that uses tissue or muscle harvested from other parts of the body to fully or partially reconstruct the breast. The tissue is usually taken from the stomach, back and buttock areas.

This technique is popular because it gives the breasts a more natural look and feel, and because it comes hand-in-hand with cosmetic surgeries such as a tummy tuck. The tissue used to reconstruct the breasts is taken from other parts of the body where there is excess tissue and fat available, which makes it serve as a body contouring procedure simultaneously.

There two types of tissue reconstruction surgeries:

?Free flap.

?Pedicled flap.

The Free Flap

This technique is the most common type of breast reconstruction procedure. The tissue used to reconstruct the breasts is completely removed from the original area, entirely separated from its original blood vessels, detached and moved to the chest.

The Pedicled Flap

This technique uses the same type of tissue, but unlike the free flap, during the pedicled flap the tissue remains attached to the original blood vessels and is moved under the skin to the chest.

Flap reconstruction procedures differ based on the area the tissue is being taken from.

There are numerous types of flaps available, based on your body type and size of your breasts.

DIEP Flap, SIEA Flap and TRAM Flap

These are breast reconstruction surgeries which use tissue collected from the abdominal area to build the new breast. These procedures are quite popular as the result of the tissue harvesting is essentially the same as the result of body contouring cosmetic procedures.


This is a breast reconstruction technique which harvests tissue from the buttocks.


This is a breast reconstruction technique which harvests tissue from the hips.

PAP Flap and TUG Flap

These are reconstruction techniques that use tissue collected from the thighs.

The flap procedures differ between themselves when it comes to the type of tissue being collected: some techniques include the harvesting of the entire muscle while others don’t.

Fat grafting is a procedure which removes excess fat from different parts of the body through liposuction, and the fat is then used to reconstruct the breasts.

Combined or Hybrid Breast Reconstruction

As the name itself suggests, the hybrid breast reconstruction surgery is a procedure which combines both autologous tissue reconstruction and the use of implants. The hybrid techniques are usually used on patients with small breasts and those who are very thin and therefore don’t have enough excess fat and skin to fully complete a breast reconstruction with harvested tissues.

There are two types of combined breast reconstruction:

Stacked DIEP Flap

This a breast reconstruction procedure in which fat, skin, and blood vessels from the lower abdomen are moved to the chest. However, some people don’t have enough excess fat and skin on their abdomen for a complete DIEP flap, which is why they have to use additional implants for the complete reconstruction of the breasts.

Latissimus Dorsi Flap

This is a procedure that uses skin, fat, and muscles from the upper back for the reconstruction of the breasts, but is accompanied by the insertion of an implant into the flap to help achieve the desired shape and size of the breasts.

The Pros and Cons of Breast Reconstruction

Both implant-based breast reconstruction and autologous tissue reconstruction have their advantages and disadvantages.

Advantages of Implant-Based Reconstruction

?Less invasive surgical procedure

?Doesn’t create additional scarring (mastectomy incisions used for the procedure)

?Stable size and shape of the breasts (unaffected by subsequent weight gain or weight loss)

Advantages of Autologous Tissue Reconstruction

?The surgery involves two procedures: breast reconstruction and a body contouring procedure (the tissue is harvested through a tummy tuck, liposuction, or other body contouring procedures which reshape the buttocks, thighs or the back).

?High tolerance for radiation treatments.

?The breasts have a more natural texture, look and feel.

What We’ve Learned:

?Implants have a low resistance to radiation therapy, so patients who are expected to undergo radiation treatment aren’t advised to use implants as the reconstructed breasts might be damaged in the process.

?Flap procedures are quite invasive, as this type of reconstruction surgery entails multiple surgical procedures at once: this means that the recovery period is longer and much more strenuous than with implants.

?Neither procedure is a one-step solution. More often than not, you’ll have to undergo additional procedures in both cases, such as nipple reconstruction, implant adjustments, or flap reshaping.

By Alex Rokvity

Alex is an English teacher as a second language, and is a passionate writer for