If you require a full mastectomy then we will discuss the option
of reconstruction with you. Breast reconstruction is not an
essential part of your cancer treatment and is not right for
everyone. It can however make a big difference to many women and
aid with their recovery. We are fortunate today to have a range of
options available. Reconstruction can be done at the time of
mastectomy or as a delayed procedure.
The three most widely used methods are:
- Latissimus dorsi flap with an implant
1. Implant: An implant is a bag filled with
saline or silicone gel that can be inserted under the chest wall
muscle at the time of mastectomy. This is suitable for someone with
a small breast who does not want a larger flap procedure. The
limitations of the method are that the implant tends to have a
"plastic feel". It is difficult to match a large breast size. The
implant will have a limited lifespan and may need to be changed in
the future requiring more surgery.
Complications of implants, include:
- Capsular contracture or hardening of the implant
- Shift or migration - the implant can move so that the shape of
the breast changes
- Leak - the implant capsule can rupture causing leaking into the
tissue and a change in the size of the breast.
Any of these problems may require removal or replacement of the
2. Latissimus dorsi flap: This involves using
one of the back muscles to provide additional tissue to cover the
implant. The muscle is released from its distal attachment and
rotated anteriorly through the axilla. The blood supply is
maintained through the proximal attachment. As this muscle is not
very big it is usually insufficient to replace the volume of the
breast and an implant is used to create the desired size and shape.
This method does provide a more natural "droop" to the breast. It
produces a scar on the back and may result in some weakness of the
Possible complications include:
Flap necrosis: if the blood supply to the muscle is damaged or
simply inadequate some or all of the flap may die. This is uncommon
and this particular flap is considered to be one of the most
durable and reliable options available.
Seroma formation: Particularly at the back where the muscle is
harvested. This will require drainage with a thin needle under
local anaesthetic. It will settle down over a period of 3 - 4
Implant complications as listed above although these are less
common thanks to the added protection provided by the muscle
3. TRAM flap: This is the transverse rectus
abdominus myocutaneous flap and involves using the abdominal fat
and skin for reconstruction. The flap is supplied by a blood vessel
running through one of the abdominal wall muscles and this is
rotated superiorly under the abdominal skin to reach the mastectomy
defect. It avoids the need for an implant and tends to give an
excellent long-term result. An advantage for some is the tummy-tuck
resulting from harvest of the flap.
Possible complications include:
- Flap necrosis - if the blood supply to the transposed tissue is
insufficient then the tissue will die and will have to be
- Fat necrosis - areas of the fatty tissue in the flap can
die causing tender, hard areas. If this affects small parts of the
tissue it may settle down over a few months but if larger areas are
affected this tissue will need to be removed surgically.
- Decreased skin sensation - there may be numb areas of skin
and the reconstructed breast will not feel the same as your
original breast tissue.
- Abdominal incisional hernia - moving the abdominal muscle
can produce weakness and bulging of the abdomen and may need to be
- Flap procedures require 4 - 5 hours in theatre and about
5 - 6 days in hospital. It may take 6 weeks or longer to fully
mobilise and get back to regular exercise and activities.
Breast reconstruction usually involves more than one operation.
The aim of the initial operation is to create an adequate breast
mound. It may be desirable to consider a procedure to the other
breast to achieve good symmetry. This might be a reduction or a
breast lift depending on the appearance of the breast and patient
Nipple reconstruction is done at a later date and is a
relatively minor operation. The nipple is recreated using local
tissue or alternatively with a graft from the healthy nipple. The
areola is usually tattooed to match the other side