Dr Michelle Locke - Plastic and Reconstructive Surgeon
Private Service, Plastic Surgery
When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast. A breast reconstruction can be performed as part of the breast removal operation (immediate reconstruction) or can be performed months or years later (delayed reconstruction).
There are two main methods of breast reconstruction: one involves using an expander and/or implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.
Implant Based Reconstruction
In implant based reconstruction, an implant filled with cohesive silicone gel is inserted underneath the chest muscle and skin. Before being inserted, the skin and muscle will often need to be stretched using a tissue expander to the required breast size. This is done by placing the tissue expander (an empty bag with a fill port) where the implant will finally go, and gradually filling it with saline over weeks or months. Once fully stretched, the expander can then be replaced by the final implant after waiting several months. This process therefore requires two operations several months apart. Each operation will probably take 1-2 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 1-2 days each time.
In this operation, tissue is taken from another part of the body and used to reconstruct the breast. The most common place to get this tissue from is your stomach. The tissue can be moved up in two ways - either remaining attached to the muscle underneath (pedicled TRAM flap) or being completely detached from your body and re-attached to blood vessels in the chest using microsurgery (free DIEP flap). Flap reconstruction is generally a more complicated operation than having an implant but can produce a more natural breast using your own tissue. A pedicled flap may take 4-5 hours and a free flap may last 8 hours or more. In each case, you will require a 3 to 5 day stay in hospital.