Cosmetic Surgery Tips

Mastectomy Reconstruction With Tummy Tuck

If you’re looking for a comprehensive guide to mastectomy and tummy tuck, you’ve come to the right place.

We’ll walk you through what to expect, how to prepare, and the best ways to recover after your surgery.

You’ll learn about:

-the different types of mastectomy procedures

-what happens during surgery

-what to do when you’re home from the hospital

-tips for getting back into shape post-surgery

Right here on Cosmeticsurgerytips, you are privy to a litany of relevant information on double mastectomy and tummy tuck, types of breast reconstruction after mastectomy, Mastectomy, and so much more. Take out time to visit our catalog for more information on similar topics.

If you’re looking for a comprehensive guide to mastectomy and tummy tuck, you’ve come to the right place.

We’ll walk you through what to expect, how to prepare, and the best ways to recover after your surgery.

You’ll learn about:

-the different types of mastectomy procedures

-what happens during surgery

-what to do when you’re home from the hospital

-tips for getting back into shape post-surgery

Right here on Cosmeticsurgerytips, you are privy to a litany of relevant information on double mastectomy and tummy tuck, types of breast reconstruction after mastectomy, Mastectomy, and so much more. Take out time to visit our catalog for more information on similar topics.

Mastectomy Reconstruction with Tummy Tuck

Your surgeon might be able to use your own body tissue to make a new breast during a mastectomy operation or some time afterwards. They call this a flap reconstruction.

Using body tissue to make a new breast

To do this your surgeon takes skin, fat, and sometimes muscle (a flap) from another part of your body and makes it into a breast shape. The flap needs a good blood supply, or the tissue will die. So the surgeon will leave the body tissue connected to its original blood vessels. Or they can cut the blood vessels and reconnect them to blood vessels under your arm or in your chest wall. 

If your surgeon leaves the flap connected to its own blood supply it is called a pedicled flap.

If they connect the flap to new blood vessels, this involves microsurgery and they call it a free flap.

Before your surgery, you may have a type of CT scan called a CT angiogram. This looks at the blood supply of the tissue that’s used to create the new breast.

Who has body tissue reconstruction?

Flap reconstruction methods might suit you if:

  • you have large breasts
  • you have had radiotherapy
  • you had a radical mastectomy with removal of your chest muscle
  • you have a tight mastectomy scar 
  • you want a softer and more realistic result than a silicone implant might give 
  • you are not able to have an implant

Who can’t have this type of surgery?

This type of surgery may not be suitable if you have diabetes, are a heavy smoker, or are very overweight. 

Types of body tissue reconstruction

Your surgeon can reconstruct your breast by:

  • using a flap from your back (latissimus dorsi flap) 
  • using a flap from your abdomen (TRAM flap) 
  • using just skin and fat from the abdomen (DIEP reconstruction)
  • using just skin and fat from the buttock (SGAP or IGAP)
  • using skin, fat and muscle from the thigh (TMG or TUG) 

Radiotherapy and flap reconstruction

If you have radiotherapy to a flap, this won’t affect it straight away. But it is may cause changes to the reconstructed breast in the future. After about 10 years the flap might shrink, discolour, harden, or change shape. You might then need further surgery to create a flap from a different part of the body.

Using a flap from your back (latissimus dorsi flap)

The latissimus dorsi is a muscle in your back, under your shoulder blade. Its job is to move the arm into your side and backwards. Other muscles around the shoulder also do the same job.

Your surgeon uses the muscle, and the skin and fat covering it, to make a new breast. You might need to have an implant put in as well if you have larger breasts. Or you could have the other breast made smaller.

The surgeon tunnels the flap under the skin to the front of the body to make the new breast. This is called a pedicled flap. With this type of reconstruction, the flap keeps its original blood supply.

Diagram showing reconstruction of the breast using the latissimus dorsi muscle and an implant

You will have a scar on your back, roughly 6 inches (15cm) long. You can choose to have the scar horizontally so you can hide it under your bra. Or you can have it diagonally if you don’t want it to show under backless clothes. You can discuss the position of the scar with your surgeon.

If you are having the reconstruction after your mastectomy, you will also have an oval scar on the reconstructed breast.

Diagram showing breast using the latissimus dorsi muscle

A latissmus dorsi flap operation takes less time to recover from than an operation using the abdominal muscles. You will be in hospital for about 4 days. It takes about 4 weeks to get over the surgery.

Using a flap from your abdomen (TRAM flap)

The rectus abdominis muscle is in your tummy (abdomen) and runs from your breastbone to your pubic bone. For a TRAM flap reconstruction the surgeon takes part of this muscle, with its skin, fat, and blood vessels. They move it to your chest wall to make a new breast.

The most common way of creating the new breast is called a free flap. Your surgeon completely cuts away the skin and fat from the abdomen. They then connect the flap’s blood vessels to blood vessels in the chest wall or armpit.

The surgeon will stitch up your abdomen in a similar way to having a tummy tuck.

Diagram to show TRAM flap reconstruction

After a TRAM flap

After the operation, you stay on bed rest for about 48 hours. You may have a tube draining urine from your bladder (a catheter) so you don’t have to get up. Your room will be kept very warm to encourage a good blood flow to the flap.

You will have a scar running across your abdomen (horizontally). If you have the reconstruction after you had your mastectomy, you will also have an oval scar on the reconstructed breast.

You might feel uncomfortable for a while after your abdominal operation. Recovery takes longer than for the back flap method and you will be in hospital for about a week. It will be about 7 weeks in all before you have recovered. But it takes another 6 months or more before your tummy is as supple as before.

Possible complications

There is a risk of blood clots blocking the blood vessels in the flap, which cuts off the blood supply and the flap tissue will die. This complication can be serious but is not very common.

After TRAM flap reconstruction, the abdominal muscle can be weaker. This increases your risk of having a hernia in the future. Sometimes surgeons fix a piece of mesh in place during the operation to help strengthen the abdominal wall. 

Taking just skin and fat from the abdomen (DIEP reconstruction)

A DIEP reconstruction is very similar to abdominal muscle reconstruction. But the surgeon only takes skin and fat from the abdomen to make the breast shape. They leave the abdominal muscle in place as they remove the skin and fat along with the blood vessel that keeps the tissue alive.

DIEP stands for deep inferior epigastric perforators, which are the blood vessels used in the reconstruction.

The surgeon carefully teases out the blood vessel from the muscle. The advantage of this operation is that the abdominal wall is not so weakened, because the muscle is still there. So there is less risk of hernia afterwards.

Diagram showing area removed for a DIEP beast reconstruction

With these flaps the surgeon uses microsurgery to join up the flap’s blood vessels to small blood vessels in the chest wall or armpit. As with the free TRAM flap, the blood supply can become completely blocked off with clots.

Some women may need to go back to the operating theatre within a few days to improve the blood supply. If the blood supply is cut off, the flap tissue dies and the reconstruction will fail, but this is rare.

Having a DIEP flap allows you to keep as much abdominal strength as possible. So you might want to have a DIEP reconstruction if your abdominal strength is very important to you. Do to talk to your surgeon about the benefits and risks of surgery and what is best for you.

Taking fat and skin from the buttocks (SGAP or IGAP)

Your surgeon might use microsurgery to move fat and skin from the buttock to create new breast tissue.

Taking tissue from the upper part of the buttock is a superior gluteal artery perforator flap (SGAP).

Taking tissue from the lower part of the buttock is an inferior gluteal artery perforator flap (IGAP).

Taking tissue from the buttock leaves a dent in that area and a small scar. Because the buttock tissue is often thicker than normal breast tissue it means your new breast can be a bit firmer than with other types of reconstruction.

These operations are more difficult than taking tissue from the back or abdomen and more likely to have complications. So this type of reconstruction is not commonly used and is generally for women who can’t have other types. Your surgeon might offer it if you are too slim to take tissue from the abdomen or if you have scarring from previous surgery in the abdomen or back.

Only a few surgeons in the UK can do this surgery and you might need to travel to a specialist hospital.

Taking fat, skin and muscle from the thigh (TMG or TUG)

Your surgeon might use microsurgery to move fat, skin and muscle from the upper part of the thigh.

Taking tissue from the outer part of the thigh is called a transverse myocutaneous gracilis flap (TMG), a lateral thigh flap, or a saddle bag flap.

Taking tissue from the inner part of the thigh is a transverse upper gracilis flap (TUG).

The operation leaves a dent in the thigh and a scar. 

These operations generally only give a small amount of tissue. So your surgeon might only consider them if you can’t have back or abdominal muscle reconstruction. Your surgeon may offer these operations if you are too slim to take tissue from the abdomen or if you have scarring from previous surgery in the abdomen or back.

Only a few surgeons in the UK can do this type of reconstruction and you may need to travel to a specialist hospital.

Reshaping the breast (lipomodelling)

Sometimes after surgery, the breast can look uneven. Surgeons can adjust the shape by injecting fat into the breast. They call this lipomodelling or lipofilling. 

This technique can improve the appearance of the breast by filling in dents after breast conserving surgery. It can also help to reshape the breast after breast reconstruction.

How you have lipomodelling

Surgeons remove fat from other parts of the body, for example, the hip or thighs. They do this by inserting a narrow tube (cannula) into the fat through a tiny cut (incision). They create suction using a vacuum pump or a large syringe. 

Your surgeon then injects the fat into the dents in the reconstructed breast to improve the shape. You usually have this as a day case, either under a general anaesthetic or local anaesthetic.

The scars from this procedure are small and often in an area where they can’t be seen.

Afterwards you may notice some bruising or have some pain around the areas where the fat was taken, these will gradually improve. Some fat is often absorbed into the body over time, so you may need to have this procedure more than once. 

Possible effects of injecting fat

Some surgeons have reported that injecting fat into the breast seems to reverse some of the side effects of radiotherapy. It seems to reduce thickening of the tissue in the radiotherapy area and reduce skin tightness. It might also lessen the appearance of blood vessels under the skin (telangiectasia). Some small research studies seem to support this finding. 

There are some theories about why the fat reverses these radiotherapy side effects. Surgeons think that stem cells in the transplanted fat tissue might stimulate healthy breast tissue to develop in the area. Or it may be because fat can create new blood vessels that increase the blood supply.

After reconstruction surgery

Looking after you wound

After surgery the wound is covered with a surgical dressing. Before you go home your nurse will give you instructions on caring for the wound. This will include showering the area and possible problems you should be aware of.

Bras and underwear  

Your bra can help to support the reconstruction. Your surgeon or breast cancer nurse may suggest you wear a soft supportive bra after your surgery. This may be day and night for a couple of weeks.

You may find that a bra that fastens at the front is more comfortable. If you have any swelling, you might need a slightly larger size than usual for a short time.

Your nurse may also suggest that you wear supportive underwear on your lower half. This is for women who have a reconstruction using muscle from their thighs, tummy, or buttock. This helps to reduce swelling and support the wound.

Do speak to your nurse or surgeon before your surgery. They may be able to suggest local places to buy these.

Exercise

After the surgery you need to do some exercises to get your arm and shoulder moving properly again. Your nurse or physiotherapist will show you what to do and explain when to do them.

Follow up

This will vary, your nurse will let you know how often you will need follow up appointments. 

You will still have regular mammograms of your other breast. You will not need one for the reconstructed breast unless you have some remaining breast tissue. Do ask you nurse if you are not sure.

Types Of Breast Reconstruction After Mastectomy

Breast reconstruction is surgery to recreate breasts after mastectomy or lumpectomy. Sometimes reconstruction takes several surgeries. There are many breast reconstruction techniques. Some use silicone or saline breast implants. Other techniques use a flap of tissue from your body (such as tissue from the lower belly).

Breast reconstruction can happen right after breast cancer surgery (immediate reconstruction). Or it can happen months or years later (delayed reconstruction). You may have surgery to reconstruct both breasts. Or your provider may replace one breast and reshape it to match the other. Your provider may recommend multiple surgeries over several stages.

Some people choose to have breast reconstruction after a mastectomy, but many don’t. The decision to have breast reconstruction is very personal.

What are the types of breast reconstruction surgery?

There are two main types of breast reconstruction surgery after mastectomies.

Flap reconstruction

In flap reconstruction, your surgeon takes tissue from your own body (autologous tissue) and uses it to form a breast. Usually, they take the tissue from the lower abdomen (belly). But it can also come from your thigh, back or bottom.

Your surgeon may remove fat, skin, blood vessels and muscle from these parts of your body to form a new breast. Healthcare providers call this tissue a flap. Sometimes, surgeons move a flap through your body (pedicled flap). This way the flap retains its own blood supply. Or they may detach the flap from its blood supply (free flap) and attach it to blood vessels in your chest.

The types of flap reconstruction include:

  • DIEP flap: Your provider takes skin, fat and blood vessels from the lower belly. A DIEP flap does not remove the underlying abdominal (belly) muscle.
  • TRAM flap: Your provider removes skin, fat, blood vessels and muscle from the lower belly.
  • Latissimus dorsi (LD) flap: Providers remove tissue and muscle from the back. They transplant the LD flap (still connected to its own blood supply) through the back to the breast area.
  • IGAP flap: For this procedure, tissue comes from your butt. Muscle isn’t used in this procedure.
  • SGAP flap: This technique also removes tissue (not muscle) from your butt. It uses a different group of blood vessels than the IGAP flap procedure.
  • PAP flap: Your surgeon removes tissue from the inner and back of your thigh and uses it to form a breast. This procedure does not transplant muscle from your thigh.
  • TUG flap: Similar to a PAP flap, this technique uses tissue from your thigh. A TUG flap transplants muscle as well as tissue.
  • SIEA flap (or SIEP flap): This procedure is like a DIEP flap, but it uses different blood vessels. Providers don’t use this technique as often. Few people have the blood vessels necessary for the surgery to be successful.

Implant reconstruction

In implant reconstruction, surgeons use saline or silicone implants to recreate breast tissue. Sometimes surgeons use a combination of implants and tissue from your body. Implant reconstruction can happen along with a mastectomy. Or you may choose to have this procedure after a mastectomy.

The types of implant reconstruction are:

  • Under the chest muscle: Your surgeon lifts up the chest muscle and places the implant underneath it.
  • Above the chest muscle: Your surgeon places the implant on top of the chest muscle. You may not need as much recovery time because your chest muscle remains in place.
  • Implant with tissue expander: Your surgeon places an expander under your skin. About once per week, you or your healthcare provider fills the expander with saline. Your skin gradually expands (stretches). Your surgeon will place the implant once your skin has expanded enough to cover it.

Oncoplastic reconstruction after lumpectomy

If you are a candidate for lumpectomy, you may benefit from oncoplastic reconstruction. Your oncologic breast surgeon will help you know if you are a candidate for breast conservation. However, you’ll require radiation when a lumpectomy is performed.

In oncoplastic reconstruction, surgeons use the techniques of breast reduction or breast lift at the same time as the lumpectomy. The breast reduction or breast lift helps to fill in the defect created by the lumpectomy and improves the breast shape. You’ll need a breast reduction or lift on the other breast for symmetry.

Can a nipple be reconstructed?

Some types of mastectomy leave the nipple and areola in place (nipple-sparing mastectomy). The areola is the dark skin surrounding the nipple. If necessary, providers can create a new nipple. They do this by transferring skin from another part of your body (skin graft) or local skin on the breast to shape into a nipple.

Some people choose to get a 3D tattoo of an areola after nipple reconstruction. Specially trained tattoo artists create realistic images of an areola.

How do I know what type of breast reconstruction surgery to get?

Your provider will recommend the most appropriate technique for you based on:

  • Your age, overall health and lifestyle.
  • The kind of mastectomy or lumpectomy you had and how much tissue remains.
  • Whether you need additional treatments for breast cancer (such as chemotherapy or radiation).
  • Past surgeries you’ve had that may make it difficult or impossible to take a flap from your belly. One example is abdominal surgery.
  • Your goals and desired appearance.

What does breast reconstruction treat?

Most often, breast reconstruction happens after surgery to treat or prevent breast cancer. Providers use it to reshape breasts and rebuild damaged or missing tissue. They may also perform this surgery to restore symmetry. This means they make both breasts the same size and shape. Less commonly, providers reconstruct breast tissue that results from congenital abnormalities (birth defects).

After a mastectomy, it’s normal to mourn the loss of your breast. Breast reconstruction surgery helps many people manage these strong emotions and move forward.

PROCEDURE DETAILS

What happens before breast reconstruction surgery?

Breast reconstruction happens after a mastectomy or lumpectomy. If you have breast cancer, you may also need chemotherapy or radiation before breast reconstruction surgery. Your surgeon will ask you about your goals and discuss your surgical options with you.

First, your surgeon will conduct a comprehensive examination. They will measure and take photographs of your breasts. Tell your provider about your health, medications you take and any surgeries you’ve had. Your provider may ask you to stop taking certain medications before the procedure.

What happens during breast reconstruction surgery?

A surgeon will perform your breast reconstruction surgery in a hospital. Your provider gives you anesthesia, so you’ll be asleep and you won’t feel any pain during the surgery. If you’re having a mastectomy or lumpectomy, your surgeon will do that procedure first.

While you’re still asleep, your surgeon performs the breast reconstruction. If you’re getting implant reconstruction, they place the implant in your chest. If you’re having a flap procedure, they take tissue from one part of your body, form and place the new breast.

During surgery, your provider may insert a drain (a thin tube) under your skin. One end of the tube sticks out from your chest. The tube drains fluid and blood as you recover. Your provider will remove the tubes when you don’t need them anymore.

What happens after breast reconstruction surgery?

After surgery, you may need to stay in the hospital for up to a week. Your team of providers will watch you to ensure you’re healing. You may wear a surgical bra. As your breasts heal, the bra supports your breasts and reduces swelling. When it’s time to go home, your provider will give you instructions detailing how to care for yourself.

Your provider will help you manage pain after surgery. They may recommend prescription or over-the-counter pain medication. Follow your provider’s instructions carefully when taking medication.

If you had reconstruction on one breast, you may need more surgery to make your breasts match. This may include breast reduction surgery or breast augmentation.

RISKS / BENEFITS

What are the advantages of breast reconstruction surgery?

Breast reconstruction surgery can improve self-confidence after a mastectomy or lumpectomy. After breast reconstruction, many people feel better about how their clothes fit. They may also feel more comfortable wearing a swimsuit.

Many people choose not to have breast reconstruction after a mastectomy. Instead, they wear a breast form (prosthesis) inside a special bra. They may also choose to “go flat” and not wear prosthetic breasts. The decision is very personal and varies from person to person.

What are the risks or complications of breast reconstruction surgery?

As with any surgical procedure, risks of breast reconstruction include infection and bleeding. Results vary depending on the type of procedure and how much tissue remained after breast cancer surgery and radiation.

After surgery, you’ll probably have little or no sensation in your newly reconstructed breasts. Over time, you may regain some sensation in the skin. But it won’t feel like it did before.

Complications of breast reconstruction surgery may include:

  • Blood clots. These may be more likely to happen after some types of flap reconstruction surgeries.
  • Breasts that are a different size or shape. One may feel more firm than the other. The nipples and areolas may not be symmetrical.
  • Bruising or scarring around the reconstructed breasts. All breast reconstruction surgeries leave scars. They may fade over time.
  • Necrosis (death) of the transplanted tissue after flap surgery.
  • Problems with the implants (for implant reconstruction). These problems can include wrinkling, rippling and ruptures (tears) in the implant.
  • Weakness, pain or sensitivity at the donor site after a flap reconstruction procedure. Donor sites may include the lower belly, thigh, back or bottom.

Do implants carry extra risk?

Some implants may increase the risk of anaplastic large cell lymphoma (ALCL), a rare form of cancer. Most of these implants are no longer on the market in the United States. Ask your provider about the risk of developing ALCL after implant surgery.

RECOVERY AND OUTLOOK

When can I go back to my usual activities after breast reconstruction surgery?

Everyone recovers from surgery differently. Your recovery time depends on several factors. These include your overall health and the type of procedure you had.

You will need to avoid lifting, exercising or doing some activities for a while to give your body time to heal. Talk to your provider about when you can get back to the activities you enjoy.

Cancer can return after breast reconstruction surgery. See your provider for regular checkups. If you had one breast reconstructed, you’ll need regular mammograms on the other breast to check for cancer.

WHEN TO CALL THE DOCTOR

When should I see my healthcare provider about breast reconstruction surgery?

Call your provider right away if you have:

  • Signs of infection, such as fever.
  • Severe pain or pain that doesn’t get better with medications.
  • Bleeding or fluid (pus) coming from the incisions.
  • Changes in color on the breast or near the incisions.

Your surgeon might be able to use your own body tissue to make a new breast during a mastectomy operation or some time afterwards. They call this a flap reconstruction.

Using body tissue to make a new breast

To do this your surgeon takes skin, fat, and sometimes muscle (a flap) from another part of your body and makes it into a breast shape. The flap needs a good blood supply, or the tissue will die. So the surgeon will leave the body tissue connected to its original blood vessels. Or they can cut the blood vessels and reconnect them to blood vessels under your arm or in your chest wall. 

If your surgeon leaves the flap connected to its own blood supply it is called a pedicled flap.

If they connect the flap to new blood vessels, this involves microsurgery and they call it a free flap.

Before your surgery, you may have a type of CT scan called a CT angiogram. This looks at the blood supply of the tissue that’s used to create the new breast.

Who has body tissue reconstruction?

Flap reconstruction methods might suit you if:

  • you have large breasts
  • you have had radiotherapy
  • you had a radical mastectomy with removal of your chest muscle
  • you have a tight mastectomy scar 
  • you want a softer and more realistic result than a silicone implant might give 
  • you are not able to have an implant

Who can’t have this type of surgery?

This type of surgery may not be suitable if you have diabetes, are a heavy smoker, or are very overweight. 

Types of body tissue reconstruction

Your surgeon can reconstruct your breast by:

  • using a flap from your back (latissimus dorsi flap) 
  • using a flap from your abdomen (TRAM flap) 
  • using just skin and fat from the abdomen (DIEP reconstruction)
  • using just skin and fat from the buttock (SGAP or IGAP)
  • using skin, fat and muscle from the thigh (TMG or TUG) 

Radiotherapy and flap reconstruction

If you have radiotherapy to a flap, this won’t affect it straight away. But it is may cause changes to the reconstructed breast in the future. After about 10 years the flap might shrink, discolour, harden, or change shape. You might then need further surgery to create a flap from a different part of the body.

Using a flap from your back (latissimus dorsi flap)

The latissimus dorsi is a muscle in your back, under your shoulder blade. Its job is to move the arm into your side and backwards. Other muscles around the shoulder also do the same job.

Your surgeon uses the muscle, and the skin and fat covering it, to make a new breast. You might need to have an implant put in as well if you have larger breasts. Or you could have the other breast made smaller.

The surgeon tunnels the flap under the skin to the front of the body to make the new breast. This is called a pedicled flap. With this type of reconstruction, the flap keeps its original blood supply.

Diagram showing reconstruction of the breast using the latissimus dorsi muscle and an implant

You will have a scar on your back, roughly 6 inches (15cm) long. You can choose to have the scar horizontally so you can hide it under your bra. Or you can have it diagonally if you don’t want it to show under backless clothes. You can discuss the position of the scar with your surgeon.

If you are having the reconstruction after your mastectomy, you will also have an oval scar on the reconstructed breast.

Diagram showing breast using the latissimus dorsi muscle

A latissmus dorsi flap operation takes less time to recover from than an operation using the abdominal muscles. You will be in hospital for about 4 days. It takes about 4 weeks to get over the surgery.

Using a flap from your abdomen (TRAM flap)

The rectus abdominis muscle is in your tummy (abdomen) and runs from your breastbone to your pubic bone. For a TRAM flap reconstruction the surgeon takes part of this muscle, with its skin, fat, and blood vessels. They move it to your chest wall to make a new breast.

The most common way of creating the new breast is called a free flap. Your surgeon completely cuts away the skin and fat from the abdomen. They then connect the flap’s blood vessels to blood vessels in the chest wall or armpit.

The surgeon will stitch up your abdomen in a similar way to having a tummy tuck.

Diagram to show TRAM flap reconstruction

After a TRAM flap

After the operation, you stay on bed rest for about 48 hours. You may have a tube draining urine from your bladder (a catheter) so you don’t have to get up. Your room will be kept very warm to encourage a good blood flow to the flap.

You will have a scar running across your abdomen (horizontally). If you have the reconstruction after you had your mastectomy, you will also have an oval scar on the reconstructed breast.

You might feel uncomfortable for a while after your abdominal operation. Recovery takes longer than for the back flap method and you will be in hospital for about a week. It will be about 7 weeks in all before you have recovered. But it takes another 6 months or more before your tummy is as supple as before.

Possible complications

There is a risk of blood clots blocking the blood vessels in the flap, which cuts off the blood supply and the flap tissue will die. This complication can be serious but is not very common.

After TRAM flap reconstruction, the abdominal muscle can be weaker. This increases your risk of having a hernia in the future. Sometimes surgeons fix a piece of mesh in place during the operation to help strengthen the abdominal wall. 

Taking just skin and fat from the abdomen (DIEP reconstruction)

A DIEP reconstruction is very similar to abdominal muscle reconstruction. But the surgeon only takes skin and fat from the abdomen to make the breast shape. They leave the abdominal muscle in place as they remove the skin and fat along with the blood vessel that keeps the tissue alive.

DIEP stands for deep inferior epigastric perforators, which are the blood vessels used in the reconstruction.

The surgeon carefully teases out the blood vessel from the muscle. The advantage of this operation is that the abdominal wall is not so weakened, because the muscle is still there. So there is less risk of hernia afterwards.

Diagram showing area removed for a DIEP beast reconstruction

With these flaps the surgeon uses microsurgery to join up the flap’s blood vessels to small blood vessels in the chest wall or armpit. As with the free TRAM flap, the blood supply can become completely blocked off with clots.

Some women may need to go back to the operating theatre within a few days to improve the blood supply. If the blood supply is cut off, the flap tissue dies and the reconstruction will fail, but this is rare.

Having a DIEP flap allows you to keep as much abdominal strength as possible. So you might want to have a DIEP reconstruction if your abdominal strength is very important to you. Do to talk to your surgeon about the benefits and risks of surgery and what is best for you.

Taking fat and skin from the buttocks (SGAP or IGAP)

Your surgeon might use microsurgery to move fat and skin from the buttock to create new breast tissue.

Taking tissue from the upper part of the buttock is a superior gluteal artery perforator flap (SGAP).

Taking tissue from the lower part of the buttock is an inferior gluteal artery perforator flap (IGAP).

Taking tissue from the buttock leaves a dent in that area and a small scar. Because the buttock tissue is often thicker than normal breast tissue it means your new breast can be a bit firmer than with other types of reconstruction.

These operations are more difficult than taking tissue from the back or abdomen and more likely to have complications. So this type of reconstruction is not commonly used and is generally for women who can’t have other types. Your surgeon might offer it if you are too slim to take tissue from the abdomen or if you have scarring from previous surgery in the abdomen or back.

Only a few surgeons in the UK can do this surgery and you might need to travel to a specialist hospital.

Taking fat, skin and muscle from the thigh (TMG or TUG)

Your surgeon might use microsurgery to move fat, skin and muscle from the upper part of the thigh.

Taking tissue from the outer part of the thigh is called a transverse myocutaneous gracilis flap (TMG), a lateral thigh flap, or a saddle bag flap.

Taking tissue from the inner part of the thigh is a transverse upper gracilis flap (TUG).

The operation leaves a dent in the thigh and a scar. 

These operations generally only give a small amount of tissue. So your surgeon might only consider them if you can’t have back or abdominal muscle reconstruction. Your surgeon may offer these operations if you are too slim to take tissue from the abdomen or if you have scarring from previous surgery in the abdomen or back.

Only a few surgeons in the UK can do this type of reconstruction and you may need to travel to a specialist hospital.

Reshaping the breast (lipomodelling)

Sometimes after surgery, the breast can look uneven. Surgeons can adjust the shape by injecting fat into the breast. They call this lipomodelling or lipofilling. 

This technique can improve the appearance of the breast by filling in dents after breast conserving surgery. It can also help to reshape the breast after breast reconstruction.

How you have lipomodelling

Surgeons remove fat from other parts of the body, for example, the hip or thighs. They do this by inserting a narrow tube (cannula) into the fat through a tiny cut (incision). They create suction using a vacuum pump or a large syringe. 

Your surgeon then injects the fat into the dents in the reconstructed breast to improve the shape. You usually have this as a day case, either under a general anaesthetic or local anaesthetic.

The scars from this procedure are small and often in an area where they can’t be seen.

Afterwards you may notice some bruising or have some pain around the areas where the fat was taken, these will gradually improve. Some fat is often absorbed into the body over time, so you may need to have this procedure more than once. 

Possible effects of injecting fat

Some surgeons have reported that injecting fat into the breast seems to reverse some of the side effects of radiotherapy. It seems to reduce thickening of the tissue in the radiotherapy area and reduce skin tightness. It might also lessen the appearance of blood vessels under the skin (telangiectasia). Some small research studies seem to support this finding. 

There are some theories about why the fat reverses these radiotherapy side effects. Surgeons think that stem cells in the transplanted fat tissue might stimulate healthy breast tissue to develop in the area. Or it may be because fat can create new blood vessels that increase the blood supply.

After reconstruction surgery

Looking after you wound

After surgery the wound is covered with a surgical dressing. Before you go home your nurse will give you instructions on caring for the wound. This will include showering the area and possible problems you should be aware of.

Bras and underwear  

Your bra can help to support the reconstruction. Your surgeon or breast cancer nurse may suggest you wear a soft supportive bra after your surgery. This may be day and night for a couple of weeks.

You may find that a bra that fastens at the front is more comfortable. If you have any swelling, you might need a slightly larger size than usual for a short time.

Your nurse may also suggest that you wear supportive underwear on your lower half. This is for women who have a reconstruction using muscle from their thighs, tummy, or buttock. This helps to reduce swelling and support the wound.

Do speak to your nurse or surgeon before your surgery. They may be able to suggest local places to buy these.

Exercise

After the surgery you need to do some exercises to get your arm and shoulder moving properly again. Your nurse or physiotherapist will show you what to do and explain when to do them.

Follow up

This will vary, your nurse will let you know how often you will need follow up appointments. 

You will still have regular mammograms of your other breast. You will not need one for the reconstructed breast unless you have some remaining breast tissue. Do ask you nurse if you are not sure.

Types Of Breast Reconstruction After Mastectomy

Breast reconstruction is surgery to recreate breasts after mastectomy or lumpectomy. Sometimes reconstruction takes several surgeries. There are many breast reconstruction techniques. Some use silicone or saline breast implants. Other techniques use a flap of tissue from your body (such as tissue from the lower belly).

Breast reconstruction can happen right after breast cancer surgery (immediate reconstruction). Or it can happen months or years later (delayed reconstruction). You may have surgery to reconstruct both breasts. Or your provider may replace one breast and reshape it to match the other. Your provider may recommend multiple surgeries over several stages.

Some people choose to have breast reconstruction after a mastectomy, but many don’t. The decision to have breast reconstruction is very personal.

What are the types of breast reconstruction surgery?

There are two main types of breast reconstruction surgery after mastectomies.

Flap reconstruction

In flap reconstruction, your surgeon takes tissue from your own body (autologous tissue) and uses it to form a breast. Usually, they take the tissue from the lower abdomen (belly). But it can also come from your thigh, back or bottom.

Your surgeon may remove fat, skin, blood vessels and muscle from these parts of your body to form a new breast. Healthcare providers call this tissue a flap. Sometimes, surgeons move a flap through your body (pedicled flap). This way the flap retains its own blood supply. Or they may detach the flap from its blood supply (free flap) and attach it to blood vessels in your chest.

The types of flap reconstruction include:

  • DIEP flap: Your provider takes skin, fat and blood vessels from the lower belly. A DIEP flap does not remove the underlying abdominal (belly) muscle.
  • TRAM flap: Your provider removes skin, fat, blood vessels and muscle from the lower belly.
  • Latissimus dorsi (LD) flap: Providers remove tissue and muscle from the back. They transplant the LD flap (still connected to its own blood supply) through the back to the breast area.
  • IGAP flap: For this procedure, tissue comes from your butt. Muscle isn’t used in this procedure.
  • SGAP flap: This technique also removes tissue (not muscle) from your butt. It uses a different group of blood vessels than the IGAP flap procedure.
  • PAP flap: Your surgeon removes tissue from the inner and back of your thigh and uses it to form a breast. This procedure does not transplant muscle from your thigh.
  • TUG flap: Similar to a PAP flap, this technique uses tissue from your thigh. A TUG flap transplants muscle as well as tissue.
  • SIEA flap (or SIEP flap): This procedure is like a DIEP flap, but it uses different blood vessels. Providers don’t use this technique as often. Few people have the blood vessels necessary for the surgery to be successful.

Implant reconstruction

In implant reconstruction, surgeons use saline or silicone implants to recreate breast tissue. Sometimes surgeons use a combination of implants and tissue from your body. Implant reconstruction can happen along with a mastectomy. Or you may choose to have this procedure after a mastectomy.

The types of implant reconstruction are:

  • Under the chest muscle: Your surgeon lifts up the chest muscle and places the implant underneath it.
  • Above the chest muscle: Your surgeon places the implant on top of the chest muscle. You may not need as much recovery time because your chest muscle remains in place.
  • Implant with tissue expander: Your surgeon places an expander under your skin. About once per week, you or your healthcare provider fills the expander with saline. Your skin gradually expands (stretches). Your surgeon will place the implant once your skin has expanded enough to cover it.

Oncoplastic reconstruction after lumpectomy

If you are a candidate for lumpectomy, you may benefit from oncoplastic reconstruction. Your oncologic breast surgeon will help you know if you are a candidate for breast conservation. However, you’ll require radiation when a lumpectomy is performed.

In oncoplastic reconstruction, surgeons use the techniques of breast reduction or breast lift at the same time as the lumpectomy. The breast reduction or breast lift helps to fill in the defect created by the lumpectomy and improves the breast shape. You’ll need a breast reduction or lift on the other breast for symmetry.

Can a nipple be reconstructed?

Some types of mastectomy leave the nipple and areola in place (nipple-sparing mastectomy). The areola is the dark skin surrounding the nipple. If necessary, providers can create a new nipple. They do this by transferring skin from another part of your body (skin graft) or local skin on the breast to shape into a nipple.

Some people choose to get a 3D tattoo of an areola after nipple reconstruction. Specially trained tattoo artists create realistic images of an areola.

How do I know what type of breast reconstruction surgery to get?

Your provider will recommend the most appropriate technique for you based on:

  • Your age, overall health and lifestyle.
  • The kind of mastectomy or lumpectomy you had and how much tissue remains.
  • Whether you need additional treatments for breast cancer (such as chemotherapy or radiation).
  • Past surgeries you’ve had that may make it difficult or impossible to take a flap from your belly. One example is abdominal surgery.
  • Your goals and desired appearance.

What does breast reconstruction treat?

Most often, breast reconstruction happens after surgery to treat or prevent breast cancer. Providers use it to reshape breasts and rebuild damaged or missing tissue. They may also perform this surgery to restore symmetry. This means they make both breasts the same size and shape. Less commonly, providers reconstruct breast tissue that results from congenital abnormalities (birth defects).

After a mastectomy, it’s normal to mourn the loss of your breast. Breast reconstruction surgery helps many people manage these strong emotions and move forward.

PROCEDURE DETAILS

What happens before breast reconstruction surgery?

Breast reconstruction happens after a mastectomy or lumpectomy. If you have breast cancer, you may also need chemotherapy or radiation before breast reconstruction surgery. Your surgeon will ask you about your goals and discuss your surgical options with you.

First, your surgeon will conduct a comprehensive examination. They will measure and take photographs of your breasts. Tell your provider about your health, medications you take and any surgeries you’ve had. Your provider may ask you to stop taking certain medications before the procedure.

What happens during breast reconstruction surgery?

A surgeon will perform your breast reconstruction surgery in a hospital. Your provider gives you anesthesia, so you’ll be asleep and you won’t feel any pain during the surgery. If you’re having a mastectomy or lumpectomy, your surgeon will do that procedure first.

While you’re still asleep, your surgeon performs the breast reconstruction. If you’re getting implant reconstruction, they place the implant in your chest. If you’re having a flap procedure, they take tissue from one part of your body, form and place the new breast.

During surgery, your provider may insert a drain (a thin tube) under your skin. One end of the tube sticks out from your chest. The tube drains fluid and blood as you recover. Your provider will remove the tubes when you don’t need them anymore.

What happens after breast reconstruction surgery?

After surgery, you may need to stay in the hospital for up to a week. Your team of providers will watch you to ensure you’re healing. You may wear a surgical bra. As your breasts heal, the bra supports your breasts and reduces swelling. When it’s time to go home, your provider will give you instructions detailing how to care for yourself.

Your provider will help you manage pain after surgery. They may recommend prescription or over-the-counter pain medication. Follow your provider’s instructions carefully when taking medication.

If you had reconstruction on one breast, you may need more surgery to make your breasts match. This may include breast reduction surgery or breast augmentation.

RISKS / BENEFITS

What are the advantages of breast reconstruction surgery?

Breast reconstruction surgery can improve self-confidence after a mastectomy or lumpectomy. After breast reconstruction, many people feel better about how their clothes fit. They may also feel more comfortable wearing a swimsuit.

Many people choose not to have breast reconstruction after a mastectomy. Instead, they wear a breast form (prosthesis) inside a special bra. They may also choose to “go flat” and not wear prosthetic breasts. The decision is very personal and varies from person to person.

What are the risks or complications of breast reconstruction surgery?

As with any surgical procedure, risks of breast reconstruction include infection and bleeding. Results vary depending on the type of procedure and how much tissue remained after breast cancer surgery and radiation.

After surgery, you’ll probably have little or no sensation in your newly reconstructed breasts. Over time, you may regain some sensation in the skin. But it won’t feel like it did before.

Complications of breast reconstruction surgery may include:

  • Blood clots. These may be more likely to happen after some types of flap reconstruction surgeries.
  • Breasts that are a different size or shape. One may feel more firm than the other. The nipples and areolas may not be symmetrical.
  • Bruising or scarring around the reconstructed breasts. All breast reconstruction surgeries leave scars. They may fade over time.
  • Necrosis (death) of the transplanted tissue after flap surgery.
  • Problems with the implants (for implant reconstruction). These problems can include wrinkling, rippling and ruptures (tears) in the implant.
  • Weakness, pain or sensitivity at the donor site after a flap reconstruction procedure. Donor sites may include the lower belly, thigh, back or bottom.

Do implants carry extra risk?

Some implants may increase the risk of anaplastic large cell lymphoma (ALCL), a rare form of cancer. Most of these implants are no longer on the market in the United States. Ask your provider about the risk of developing ALCL after implant surgery.

RECOVERY AND OUTLOOK

When can I go back to my usual activities after breast reconstruction surgery?

Everyone recovers from surgery differently. Your recovery time depends on several factors. These include your overall health and the type of procedure you had.

You will need to avoid lifting, exercising or doing some activities for a while to give your body time to heal. Talk to your provider about when you can get back to the activities you enjoy.

Cancer can return after breast reconstruction surgery. See your provider for regular checkups. If you had one breast reconstructed, you’ll need regular mammograms on the other breast to check for cancer.

WHEN TO CALL THE DOCTOR

When should I see my healthcare provider about breast reconstruction surgery?

Call your provider right away if you have:

  • Signs of infection, such as fever.
  • Severe pain or pain that doesn’t get better with medications.
  • Bleeding or fluid (pus) coming from the incisions.
  • Changes in color on the breast or near the incisions.

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