Breast Reconstruction
Breast Reconstruction After Mastectomy
Reconstruction with autologous tissue, implants and complementary techniques
What is it?
Nowadays, breast reconstruction after mastectomy forms an integral part of the care that may be offered to an oncology patient, unless the patient does not wish to undergo it. It can provide a significant improvement in quality of life compared with the absence of a breast.
The timing of surgery must respect the schedule of cancer treatment, including chemotherapy or radiotherapy. Radiotherapy almost always results in reduced tissue quality.
Reconstruction with autologous tissue can create a new breast with a shape and consistency closer to the original, maintain symmetry better in the long term, and follow the patient’s weight changes.
Abdominal tissue is preferred, particularly the DIEP free flap, although a pedicled TRAM flap may be used in some cases. Another option is the pedicled latissimus dorsi myocutaneous flap, using skin and muscle from the back, which may be used in revision surgery or when abdominal tissue is unavailable.
Abdominal flaps have a texture closer to breast tissue. The abdominal result resembles a tummy tuck in many respects, although the scar cannot always be placed as close to the pubic area. With a DIEP flap, loss of abdominal-wall strength is very limited, minimising the risk of hernia and loss of abdominal strength.
Not all patients are suitable for reconstruction using autologous tissue alone. Scars in the donor area, previous pedicle injury, severe obesity, significant comorbidities, or a preference for a shorter operation may lead to implant-based reconstruction.
Implant-based reconstruction can provide good results, especially when good-quality tissue is available to cover the implant and when the opposite breast is small to moderate in size without significant ptosis; a contralateral symmetrisation mammoplasty may also be planned.
The nipple-areola complex is reconstructed during a later operation, after the position and shape of the new breast have settled. Options include a graft from the opposite nipple, local flaps, groin skin, and complementary tattooing.
Fat grafting can correct small deformities during another stage of reconstruction or as a separate procedure. Fat is harvested from areas such as the abdomen or thighs, prepared, and applied to the new breast.
Associated procedures
Frequently asked questions
Answers to common questions about the options and stages of breast reconstruction.
What is breast reconstruction after a mastectomy?
It is the reconstruction of a new breast after removal of the breast. It forms part of the care that may be offered to an oncology patient and aims to provide a significant improvement in quality of life.
What is the purpose of breast reconstruction?
The purpose is to recreate the volume and shape of the absent breast, aiming for a satisfactory result compared with the absence of a breast.
How is the timing of reconstruction coordinated with chemotherapy and radiotherapy?
The timing of surgery must respect the schedule of cancer treatment, including chemotherapy or radiotherapy. Radiotherapy can reduce tissue quality.
What are the main breast reconstruction options?
The options described include reconstruction with the patient’s own tissues, implant-based reconstruction, and complementary procedures such as nipple-areola reconstruction and fat grafting.
What are the advantages of reconstruction with autologous tissue?
Autologous tissue can create a breast with a shape and consistency closer to the original, maintain symmetry better in the long term, and follow the patient’s weight changes.
Which areas of the body can provide tissue for reconstruction?
Abdominal tissue is preferred. In selected situations, a latissimus dorsi myocutaneous flap using skin and muscle from the back may also be used.
What are DIEP and TRAM flaps?
They are techniques that use abdominal tissue to reconstruct the breast. The DIEP free flap is particularly favoured, while a pedicled TRAM flap may be used in some cases.
How can abdominal-tissue reconstruction affect the scar and abdominal wall?
The abdominal result is similar in many respects to a tummy tuck, although the scar cannot always be placed as close to the pubic area. With a DIEP flap, loss of abdominal-wall strength is very limited, minimising the risk of hernia and loss of abdominal strength.
When may a latissimus dorsi flap be used?
It may be used as a rescue technique in revision surgery or when abdominal tissues cannot be used. It is reliable, although results with abdominal tissue are usually superior.
What hospital stay and recovery may be required after autologous reconstruction?
Because these procedures are complex, a hospital stay of at least three days is expected. Returning to work may take a few weeks, and exertion should be avoided for six weeks.
Which factors may make reconstruction using only autologous tissue unsuitable?
Limiting factors may include scars in the donor area, previous pedicle injury, severe obesity, significant comorbidities, or a preference for a procedure that does not require a long operating time.
When may implant-based reconstruction be considered?
An implant may be considered when reconstruction using autologous tissue alone is unsuitable. Results tend to be better when good-quality tissue is available to cover the implant and when the opposite breast is small to moderate in size without significant ptosis; a symmetrisation mammoplasty may also be planned.
What recovery and later revisions may be required after implant-based reconstruction?
The hospital stay is usually one to two days, returning to work takes about two to three weeks, and exertion should be avoided for six weeks. Later revision may be required because of capsular contracture, asymmetry, or implant rupture.
When and how is the nipple-areola complex reconstructed?
It is reconstructed during a later operation, after the position and shape of the new breast have settled. Options described include a graft from the opposite nipple, local flaps, groin skin, and complementary tattooing.
What is the role of fat grafting in breast reconstruction?
Fat grafting can correct small deformities. It may be performed during another stage of reconstruction or as a separate procedure, using fat harvested from areas such as the abdomen or thighs.
This general information does not replace an individual medical assessment.
