In very general terms there are three types of reconstruction. A breast can be formed using the patient’s tissue alone, or a reconstruction may be done using an implant alone, or a combination of an implant covered by new tissue.

A breast reconstruction can be done at any time including immediately after mastectomy. Most Plastic Surgeons would prefer to delay a reconstruction until after radiotherapy if that is required as radiotherapy will always have an effect on the tissue or implant used in the reconstruction. The reconstructed tissues feel much softer if they have not had radiotherapy.

An autologous reconstruction uses only the patient’s tissues to rebuild a breast. The most common reconstructions use tissue from the abdominal wall (e.g. TRAM or DIEP flap) or from the back (latissimus dorsi muscle flap). There are several other less commonly used options too. Tissue from the abdomen may be “pedicled” (kept attached by a muscle) or completely separated and reattached using microvascular surgery.

Fat grafts from other areas of the body can also be used.

Each type of reconstruction has many pros and cons and what is appropriate will vary between patients depending on their body shape and type, previous pregnancies or planned future pregnancies and weight changes.

In many cases it is difficult to achieve a soft and natural reconstruction using an implant alone because the overlying tissues are very thin with the removal of both the breast and the normal overlying fatty layer. Most implants feel more natural with a thicker layer of tissue covering them.

Sometimes surgery will be performed on the unaffected breast, particularly if it is overly large or droopy. The reconstructed breast is then made to match the smaller lifted breast.

Nipple construction

Once a breast mound has been formed, a nipple can be created under local anaesthetic. Once this has healed, the nipple and new areola are tattooed to match the colour of the other side using medical grade pigments.