When a breast has been removed (mastectomy) because of cancer, it is possible in most cases to reconstruct a breast similar to a natural breast. Often, a breast reconstruction can be performed as part of the breast removal operation (immediate reconstruction), or can be performed months or years later (secondary reconstruction).

There are three common methods of breast reconstruction: tissue expansion / implant; LD flap from the back (with or without implant); and the TRAM flap from the abdomen (no implant required). There are different indications for the various techniques and careful assessment is required to plan the best and safest choice for each woman.

Sometimes surgery to the other breast is advised to achieve a good symmetrical result e.g. breast reduction, lift, or augmentation.

Expansion / implant method: this is a 2 stage technique. At the first operation an expander is placed under the skin of the breast (and muscle behind the breast). After healing for 3 weeks, injections of saline are added to the expander to restore the skin to a breast shape and size. At a second operation the expander is removed and a breast-shaped silicone gel implant is placed in the same space to give the breast shape. Implants are made in many sizes and shapes. 

 LD flap - from the back: this method moves some muscle, skin and fat from the back. Sometimes there will be sufficient tissue to make the breast without needing an implant as well. However, more often an implant is required. Usually this is done as 2 stages, with the flap used to cover an expander at the first operation. The expander is adjusted in the following weeks to give good symmetry with the other breast. At the second operation the expander is exchanged for an implant.

TRAM flap - from the abdomen: this operation moves fat and skin from the lower abdomen to the chest to make a breast. This is usually done by preserving the flap on a muscle "pedicle" so that the blood supply is maintained.  The flap is fashioned into a breast shape. This method can be used when there is sufficient spare tissue in the abdomen, and no implant is required. It is my practice to perform a preliminary operation 1 week before the reconstruction to prepare the flap for transfer. This "delay" procedure improves the blood supply to the tissues and reduces complications.

Congenital breast abnormalities may require use of these techniques also.