Surgical techniques for breast reconstruction

Generally, the breast volume can be reconstructed in two different ways:

  1. Autologous reconstruction uses your body's own tissues, such as a muscular flap from the lower abdomen or the inner thigh or the gluteal region
  2. Implant-based reconstruction uses non-organic materials, such as silicone gel-filled or saline-filled silicone implants and breast tissue expanders

Autologous Reconstruction

In autologous reconstruction, the surgeon works with your own tissue taken from another part of your body. Generally, there are two types of flap surgeries:

  • Pedicled flap surgery, in which the flap remains attached via the blood vessels to its original site at one end.
  • Free-flap surgery, which is more complex and the flap is completely removed from the donor site and then micro-surgically reconnected in the breast area. Today, free-flap surgery is a very common procedure.

Different types of flap have different indications, operation times and complication rates.

Autologous reconstruction is often combined with implants, for example if the desired volume of the reconstructed breast cannot be achieved with the patient’s own tissue.

The use of an Acellular Dermal Matrix (ADM) or Meshes is also becoming more frequent. These are obtained from natural or synthetic materials and provide a scaffold that supports the regeneration and development of the soft tissue, contributing to a positive outcome in breast reconstruction.

Apart from flap surgery, autologous reconstruction is sometimes also performed using fat transfer. Only minor defects in the breast can be corrected by using this technique, as the volume of fat obtained is lower than the volume that may be achieved with implants and it is not possible to reconstruct a complete breast.

Implant-based reconstruction

Breast surgery with implants can be primary or secondary.

Nearly all patients are suitable for primary reconstruction with breast implants, but the decision depends on the tumour biology and amount of reconstruction needed. If radiation therapy is necessary following the initial surgery, this may increase the complication rate with breast implants and therefore primary reconstruction should not be the first choice.

Secondary reconstruction requires several steps. Firstly, the skin must be expanded using a tissue expander. A tissue expander is a special type of temporary implant that is inserted unfilled, and is then filled with saline solution via a remote or an integrated valve over the course of several weeks, to slowly expand the skin until there is enough tissue to insert a permanent implant. Then, the expander is replaced with the permanent implant in the desired size.

The variety of implant shapes available today makes it possible to achieve a very natural look.

Please note that breast implants are not lifetime devices. An implant may have to be removed or replaced, with no guarantee of a satisfactory cosmetic outcome from any reoperation. Complications may lead to one or more reoperations, and the risks of a reoperation are higher than the risks of the first surgery.

Reconstruction of the nipple

Sometimes it may be not possible to save the nipple during removal of the tumour. When only one breast has been removed, the nipple can be reconstructed by using half of the nipple of the other breast. Tissue grafts from the outer ear or the big toe can also be used to reconstruct the nipple.

The areola on the breast can be reconstructed from the patient's own tissue, for example using tissue of the inner thigh. As an alternative, a naturally-looking areola may also be tattooed onto the breast.