Types of breast reconstruction

This type of breast reconstruction uses a breast implant to restore the shape and volume of the breast after a mastectomy.

Most breast implants are made of silicone, though some contain a combination of silicone and salt water (saline).

Implants can be used in immediate or delayed reconstruction.

This type of breast reconstruction uses your own tissue, including the skin, fat and sometimes a muscle, to create a new breast shape.

The tissue used to create the breast shape is called a flap. This type of reconstruction is commonly called flap or autologous reconstruction.

Tissue is most commonly taken from your tummy (lower abdomen), but can also be taken from the buttock, inner thigh or back. The area the tissue is taken from is known as the donor site.

Reconstruction using your own tissue can be used in immediate or delayed reconstruction.

You may be offered a choice between having an implant or reconstruction using your own tissue.

There are benefits and limitations of both types of reconstruction.

Should I have reconstruction with an implant?

Benefits of having reconstruction using an implant

• The operation is usually quicker than breast reconstruction using your own tissue
• Recovery time is usually shorter than breast reconstruction using your own tissue
• There’s usually less scarring and no additional scars elsewhere on your body
• Reconstruction using an implant can give a good cosmetic result

Limitations of having reconstruction using an implant

• Implants can feel firmer and colder and move less naturally than reconstruction using your own tissue
• When you’re not wearing a bra, there may be a more obvious difference in shape with the natural breast, as the reconstructed breast is less likely to droop
• You’ll have scars on or around the reconstructed breast
• As with all types of reconstruction, the reconstructed breast will have less or no sensation compared to the natural breast
• You may need surgery in the future to replace the implant if it gets damaged or if you develop hardening around the implant
• You may need surgery to the other breast to create a closer match
• If you have an expander implant you may need more hospital visits to expand the implant
• Some people may notice folds or wrinkles on the skin at the top of the implant, known as rippling

Should I have reconstruction using my own tissue?

Benefits of having reconstruction using your own tissue

• The appearance and feel can be much closer to your natural breast compared to implant reconstruction
• If you gain or lose weight the reconstructed breast will change in a similar way to the other breast
• The reconstructed breast will develop a natural droop as you age
• Although you may have a longer operation or more operations initially, you’re less likely to need further surgery in the future compared to implant reconstruction
• The procedure is suitable for all breast shapes

Limitations of having reconstruction using your own tissue

• You’ll have scars on your body where the tissue flap was taken from, as well as scars on or around the reconstructed breast
• It usually involves a longer operation, hospital stay and recovery time than implant reconstruction
• As will all types of reconstruction, the reconstructed breast will have less or no sensation compared to the natural breast
• The area of skin that is transferred from a different part of your body may be a different colour, texture or have more hair than the skin on your breast
• There’s a small risk the reconstruction flap may fail if the blood supply is not good enough

If it’s not possible to keep your nipple when you have a mastectomy and reconstruction, a nipple can be created, usually at a later date.

This can be done using surgery or a nipple tattoo, or a combination of both.

Whether you have nipple reconstruction or nipple and areola tattooing is a personal choice.

Some people feel it’s the final part of their reconstruction while others choose not to have it done. 

Nipple reconstruction

Nipple reconstruction is usually done several months after your breast reconstruction surgery. This allows the reconstructed breast to fully heal and settle into the correct position. 

Your surgeon can then position the new nipple to match the opposite side.

Nipple reconstruction involves using part of the skin from your reconstructed breast to create a nipple. It’s usually done as day surgery.

Your surgeon can talk through the operation and the risks and benefits with you. 

The reconstructed nipple usually flattens over time. 

Nipple and areola tattooing

Nipple and areola tattooing is an option if you have had a nipple reconstruction. It can give a more natural appearance and match with the opposite breast. 

It can also be offered to give the appearance of a nipple and areola without having a nipple reconstruction.

Your treatment team will let you know if they offer nipple tattooing or can refer you to another hospital to have it done. 

Some hospitals offer 3D nipple and areola tattooing, which gives a more realistic appearance of a nipple through tattooing. 

Nipple tattooing may be done over several outpatient appointments. As there is usually no sensation in the breast, the area does not need to be numbed. But sometimes a local anaesthetic may need to be applied if the area being tattooed has sensation.

Nipple prosthesis

Another option is to use prosthetic nipples.

These are artificial nipples made of soft silicone that can be worn on a reconstructed breast.

They are either self-sticking or come with special skin glue that can hold the prosthetic nipple in place for several days.

Prosthetic nipples come in different sizes and skin colours. Some hospitals custom-make them, so they match the nipple on your other breast.

Breast-conserving surgery, also known as wide local excision or lumpectomy, is the removal of the cancer with a margin (border) of normal breast tissue around it.

Most women having breast-conserving surgery will not need reconstruction.

However, surgical techniques can be used to maintain the shape and symmetry of the breast when the cancer is removed.

Combining surgery to remove the cancer with techniques to improve the look of the breast is called oncoplastic surgery.

Repositioning the remaining breast tissue

During the same operation to remove the cancer, the remaining breast tissue can be repositioned to shape the breast and fill the area where the cancer was removed.

This type of surgery is known as therapeutic mammoplasty.

This technique usually reduces the size of the affected breast. You’re likely to be offered surgery to your other breast to reduce its size and restore symmetry, either at the same time or later.

Partial breast reconstruction

This involves replacing breast tissue that’s been removed using skin and fat from the side of the chest or the back.

Procedures include:

• LICAP (lateral intercostal artery perforator) flap
• LTAP (lateral thoracic artery perforator) flap
• AICAP (anterior intercostal artery perforator) flap
• MICAP (medial intercostal artery perforator) flap

These take their name from the blood vessels in the areas of the body the tissue is taken from.

This type of reconstruction can be used when breast cancer has been removed from the outer or lower part of the breast.

Your surgeon may talk to you about other flap reconstruction options.

Marking the position of the cancer

The surgeon should mark the original site of the cancer using small surgical clips that are left in the breast.

This helps with planning radiotherapy or for future breast screening.

It’s also important if tests after surgery show more breast tissue needs to be removed.

Improving the appearance of the breast

A technique called lipomodelling may be used after breast-conserving surgery to improve the appearance of the breast.

This technique involves taking fat from one part of the body, such as the tummy, thigh or lower back, and injecting it into the breast.

Lipomodelling can be used:

• After breast-conserving surgery to improve the appearance of the breast
• After breast reconstruction to adjust the size or shape of the breast, or to hide visible rippling from an implant

Lipomodelling may also be considered:

• After a mastectomy and radiotherapy before delayed breast reconstruction to improve the skin
• To reconstruct a breast

It’s usually done under a general anaesthetic as a day case procedure, although it can be done under a local anaesthetic.

The procedure may need to be repeated several times to get the desired shape and appearance.

Most people recover well after this procedure. You’ll usually have some small scars where fat has been removed. Bruising, swelling and pain in the area where the fat is taken is common and will usually settle over time.