Breast Reconstruction Methods

This page is designed to give you an overview on the main types of breast reconstruction currently available. You can find more detail about any of the reconstruction types listed below, using the drop down menus above.

There are 3 types of mastectomy procedure currently used either for the treatment of breast cancer, to prevent the occurrence of breast cancer, or to transition from female to male, and the type of mastectomy you have/are recommended will depend on your reason for surgery, the treatment you may be having and your surgeons skill set – surgeons specialise in specific reconstruction types, and this may influence where your reconstruction takes place.

Simple
Mastectomy

Skin and/or Nipple Sparing Mastectomy; in which only the breast tissue is removed, and there is no need for axillary procedures (removal of lymph nodes). The nipple and/or skin are preserved. This procedure is suitable for patients with a small cancer located several centimetres away from the nipple-areola complex, preventative (prophylactic) surgery, and female to male transitioning. 

Total
Mastectomy

A Simple Mastectomy removing all breast tissue along with the nipple and areola, plus removal of the Sentinel Node lymph or full axillary clearance. The underlying chest muscle is not removed.

Halstead / Radical
Mastectomy

This involves the removal of all breast tissue along with the nipple and areola, the pectoralis major and minor (chest muscles), plus full axillary clearance. This method is no longer the standard mastectomy treatment for breast cancer, as the Total Mastectomy has been proven to be equally as effective, with a better cosmetic outcome and fewer potential post operative complications.

DIEP Flap Breast Reconstruction

DIEP stands for Deep Inferior Epigastric Perforator.

DIEP flap breast reconstruction uses the patient’s lower tummy skin and fat to reconstruct a breast after a mastectomy. The tissue is transplanted to the chest wall using microsurgery and shaped to form a breast.

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Unlike its predecessor, the TRAM flap, the DIEP does not use any abdominal muscles–only skin and fat are used (like a Tummy Tuck). By sparing the muscles, patients experience fewer complications (like bulging or hernia), less pain, and heal faster after surgery.

Contrary to patients undergoing implant reconstruction, patients undergoing DIEP flap enjoy a soft, warm, natural breast that will never need to be replaced. Patient may also be candidates for sensory nerve reconstruction which, when performed in conjunction with DIEP flap, helps restore breast sensation lost after the mastectomy.

Diep reconstruction is not suitable for all women, particularly those who are planning to have children, or have very little body fat. Recovery is longer than other methods of reconstruction such, as DTI, but there is rarely a need for any further surgery once healed.

TUG Flap Breast Reconstruction

TUG stands for Transvers Upper Gracilis

TUG flap breast reconstruction uses skin, fat and part of the gracilis muscle from the inner portion of the upper thigh to reconstruct a breast after a mastectomy.  The tissue is transplanted to the chest wall using microsurgery and shaped to form a warm, soft, and natural breast.

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Even though the gracilis muscles is used, patients do not usually experience any noticeable impairment in leg function or strength. 

TRAM Flap Breast Reconstruction

TRAM stands for Transverse Rectus Abdominis Myocutaneous

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TRAM flap breast reconstruction uses skin, fat and muscle taken from the abdominal wall and used in the reconstruction of a breast after mastectomy. As with the flap procedures above, the result is a soft, warm breast, using a woman own tissue.

Tissue Expander to Implant Breast Reconstruction

Tissue expander to implant breast reconstruction involves two procedures.

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During the first stage, a partially filled tissue expander is placed either above or below the chest muscle. This can be performed at the same time as the mastectomy or any time after. In the several weeks following surgery, the expanders are gradually filled in an office setting until desired breast size is achieved.

After the tissue expanders are filled, a second procedure is performed. During the second surgery, the expanders are removed and a permanent breast implant (either saline or silicone) is placed.

Some women chose to keep their expanders rather than exchange for implants, either for aesthetic reasons or because they do not wish to go through further surgery.

Direct to Implant (DTI) Breast Reconstruction

Unlike traditional implant-based breast reconstruction, direct to implant reconstruction avoids the use of tissue expanders and the final breast implant is placed at the same time as the mastectomy. 

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The implant can be placed either above or below the pectoralis muscle.  An acellular dermal matrix (ADM) or Strattice is typically used in direct to implant reconstruction procedures.  Although never visible, the ADM/Strattice can be placed over the bottom of the implant like a sling to help keep the implant in position (for implants placed under the muscle) or can surround the implant completely to provide an extra layer of coverage over the implant (for implants placed above the muscle).  

Lipomodelling

Lipomodelling also known as Fat Grafting, Fat Transfer, Structural Fat Grafting, Micro Fat Grafting, Lipofilling and Lipomodelling, is a procedure commonly performed in conjunction with other breast reconstruction procedures. Fat is liposuctioned from one area of the body (such as the flanks, abdomen, and thighs), purified, and then injected into the breast.

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Lipomodelling can help improve contour defects created by the mastectomy, as well as breast shape and size to improve the final breast reconstruction results, regardless of the reconstructive procedure performed. 

Some patients may be candidates for reconstruction of the entire breast using only fat grafting. This may involve several fat grafting procedures, and is best suited for those seeking a smaller cup size in terms of the final result. It can also be a good reconstruction choice for women who have had a lumpectomy rather than a mastectomy, and have been left with a small but visible loss of tissue in the breast that has been treated.