Types of breast reconstruction after risk-reducing mastectomy

There are two main types of breast reconstruction:

Reconstruction using a breast implant

A new breast shape can be created by placing an implant behind the skin| and muscle to create a new breast. This method is often used for immediate breast reconstruction.

Alternatively a breast shape can be created using tissue expansion. An expandable implant is placed under the skin and muscle and gradually filled to make a new breast shape.

It may then be replaced by a permanent implant.

Reconstruction using your own tissue

This method uses skin, muscle and fat from another part of the body to form the breast shape. This type of reconstruction| is more complex.

A pedicled tissue flap reconstruction| involves tunnelling skin, muscle and fat from either the back or the tummy (abdomen) through to the chest to form a new breast shape. The blood supply for the muscle stays connected to the area from which it is taken. An implant may be used behind the tissue to help give the right shape.

A free flap reconstruction| also uses skin, fat and muscle, but the tissue is removed completely and detached from its blood supply before being transferred to the breast area.The flap is connected to a new blood supply using microsurgery.

A free perforator flap reconstruction| uses skin and fat from the lower abdomen, or occasionally the buttock. This is transferred to the breast area. The skin and fat is removed completely with attached blood vessels, which are reconnected to a new blood supply using microsurgery.

No muscle is taken for this operation.

New methods in breast reconstruction surgery

During breast reconstruction surgery| your surgeon may need to use a synthetic mesh to support the implant or body tissue that has been moved from a different part of your body. This is because sometimes the implants or tissue can be fairly heavy and may need extra support to make sure that they stay in the correct position while they heal. The mesh acts a bit like a sling. Synthetic meshes are used in many different types of surgery to give extra strength and support.

A newer method to give support to a breast implant or tissue flap uses donated human or pig skin that has had all the human or pig cells removed from it (acellular). They are also called an acellular dermal matrix. Removing all the cells helps to reduce the risk of it being rejected by the body or of it carrying any diseases. The matrix can be used to support an implant or natural tissue within the breast and helps the reconstructed breast to grow and heal.

Acellular dermal matrices can also be used to extend the amount of your natural skin so that you don’t need to have tissue expansion to achieve the size of breast you want. A ‘patch’ can be stitched into place to create an instant pocket for the implant. This can also help to create a better breast fold.

The use of acellular dermal matrices is new in breast reconstruction and not all surgeons will use them. Your surgeon can discuss with you whether a dermal matrix would be suitable for you. You may need to be referred to a different surgeon and have to travel to see them.