Types of Breast Reconstruction

Reconstructed breasts can look very much like your natural breasts. But they will not have the same feeling and sensation as natural breasts. It is important to realize that no surgery will make your breasts look, feel, or have the same sensations as before surgery, nor can it erase the distress caused by cancer.

It is helpful to get a better idea of how you might look after reconstruction. Ask your plastic surgeon to connect you with at least one former patient who has had the same surgical procedure that you are considering. Most plastic surgeons will have picture books for you to look at, as well as former patients who would be willing to talk with you about reconstruction.

Reconstruction with a Tissue Flap

This procedure uses tissue from your body—your abdomen, back, thighs, or buttocks- to rebuild the breast. When your own tissue is used to create a new breast, this is called autologous reconstruction. Because they are made out of your own tissue, flaps behave more like your own body than implants. For example, they shrink or expand when you lose or gain weight.

Tissue flap procedures result in two scars, one at the breast and one at the site where tissue was removed. You will want to talk to your doctor about the type of scar that you will have in the area where the tissue is removed and how it may affect that part of your body.

Types of Tissue Flap Procedures

  • TRAM (transverse rectus abdominis muscle) Flap: Tissue from the abdomen (including skin, fat, blood vessels and at least one abdominal muscle) is used to rebuild the breast. An implant may be used to create a fuller shape. There are two types of TRAM flaps:
    • Pedicle flap: The tissue remains attached to its original blood supply and is tunneled under the skin to the breast area.
    • Free Flap: The tissue is cut away completely from its original location and is attached to a new blood supply in the chest area. Free flap procedures use microsurgery techniques to connect blood vessels and ensure proper circulation to the site.
  • Latissimus Dorsi Flap: A pedicle flap that uses tissue and muscle from the upper back, tunneled under the skin to the breast area, to create a pocket for an implant.
  • DIEP (deep inferior epigastric artery perforator) Flap: A free flap procedure that uses fat and skin, but not muscle, from the lower abdominal area. 
  • SIEA (superficial inferior epigastric artery) Flap: Uses skin and fat from the lower abdominal area. The relocated tissue is attached to a new blood supply in the chest.
  • Gluteal Free Flaps: Tissue from the buttocks, including muscle, is moved to the breast area and connected to a new blood supply to recreate the shape of the breast. If necessary, an implant can also be used to fill out the size of the new breast.
  • TUG (transverse Upper Gracilis) Flap: A breast is built from a small muscle plus skin and fat from the upper inner thigh. It can be performed on one or both breasts at the same time or separately.

Tissue Rearrangement/Oncoplastic Surgery

Oncoplastic surgery is a procedure that rearranges tissue in the affected breast and create symmetry on the unaffected breast. Oncoplastic surgery is good for women with large breasts who are having a lumpectomy. Once the general surgeon has performed the lumpectomy and feels comfortable that the cancer is surgically removed, the plastic surgeon rearranges the tissue to fill in the area where the lumpectomy occurred. The plastic surgeon then performs a reduction (mastopexy) on the other side. Radiation can be performed after reconstruction.

Nipple and Areola Reconstruction
Nipple and areola reconstruction is a separate surgery and is usually the final step in breast reconstruction. During this procedure, tissue from the reconstructed breast, opposite nipple, abdomen, eyelid, groin, inner thigh, or buttocks is used to recreate a nipple. Because reconstructed nipples tend to shrink, they are initially made up to 50% larger than your desired size. Tattooing can give the nipple a natural color to create an areola. For some women, a nipple- sparing mastectomy is an option. This type of surgery is performed when cancer is at an early stage and is located far from the nipple. It is also often an option for high-risk women who are having a preventive (prophylactic) mastectomy.