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Types of breast reconstruction

Compare the types of breast reconstruction and find out how to choose a suitable option for you.

The main types of breast reconstruction are:

  • implants to replace all or some of your breast tissue
  • having a breast shape made from your own body tissue 
  • a combination of an implant and your own body tissue

How to choose

Your surgeon might offer you a choice between different types of reconstruction. There are benefits and drawbacks to all types. You can talk about these with your breast or plastic surgeon, or your breast care nurse.

There might be good reasons why one type of reconstruction is much better for you than another. But to help you decide, we’ve listed some of the main points here.

Implant breast reconstruction

Reconstruction with an implant:

  • is simpler than other types of reconstruction
  • causes less scarring
  • gives a reasonable shape for small or medium sized breasts
  • doesn't change in size if you gain or lose weight
  • is more likely to have long term problems because the implant is a foreign body
  • feels less natural, colder and less mobile than a body tissue reconstruction
  • isn't advisable if you are going to have radiotherapy afterwards
  • might not be possible if you have had radiotherapy or don’t have healthy chest wall skin
  • might need two operations – one to stretch the skin, and the other to put a silicone implant in

The implant tends to rise up and get tighter after some time so the breasts may be out of alignment. An implant reconstruction is more likely to need further surgery than after body tissue reconstruction.

Body tissue reconstruction surgery

Tissue reconstruction gives a breast that is warm, soft and feels natural. It might avoid the need for implants.

This type of reconstruction:

  • can usually be done in one or two operations
  • is a much bigger and longer operation than implant reconstruction
  • leaves you with two wound sites after surgery and two sets of scars
  • might give a higher chance of arm weakness if you have tissue taken from your back (latissimus dorsi reconstruction)

The reconstructed breast tends to droop after some time so the breasts may be out of alignment.

Body tissue reconstruction with abdominal tissue (TRAM or DIEP flap)

This type of reconstruction:

  • gives you a flatter tummy
  • will lose or gain weight as you do
  • might not be possible if you already have surgical scars on your abdomen
  • might need surgery to the opposite breast to make a good match
  • can increase the risk of hernias in the future (weakening of the abdominal wall)

Body tissue reconstruction with back tissue (latissimus dorsi flap)

This type of reconstruction:

  • is a simpler operation than an abdominal flap (TRAM or DIEP flaps) and easier to recover from
  • is more likely to be successful because the flap has its original blood supply
  • needs to be done alongside an implant in women with larger breasts
  • uses thicker and paler skin from the back, which might cause an obvious patch on the new breast
  • might need surgery to the opposite breast to make a good match

Recreating a nipple

All reconstruction methods create a smooth breast shape without a nipple. The options for nipple reconstruction are:

  • having a nipple tattoo 
  • having a nipple made from your own body tissue
  • using a stick on nipple 

All the options create the appearance of a nipple. But the new nipple won’t have any feeling and won’t stand up when cold or touched as a real one would.

Sometimes the real nipple and skin from the breast are not removed during mastectomy. This is called a nipple sparing mastectomy. The sensation in the nipple is usually different after the operation.

Nipple reconstruction options

Nipple tattoo 

You can have a nipple tattooed onto the reconstructed breast. 

The tattoo is flat and doesn't give you the shape of a nipple. But a skilled plastic surgeon or medical tattoo professional can use colour in shades that make the flat tattoo look 3-dimensional.

Nipple made from your own body tissue 

A surgeon can make a nipple from your own body tissue. You have this done about 6 to 9 months after your breast reconstruction surgery, when everything has settled down. If you have it done earlier, the new nipple might not end up in the right place.  

There are 2 ways for a surgeon to create a nipple shape from body tissue. These methods of creating a nipple are quite minor surgery and you are usually able to have the procedure done under local anaesthetic and go home the same day.  

One way is where the surgeon gathers up some tissue from the centre of the reconstructed breast and makes it into a nipple shape. About 4 to 6 weeks later, you can have the nipple and the area around it (the areola) tattooed to match your other nipple.

About half the nipples made like this gradually flatten and shrink until they are almost gone. You can have the surgery again, but unfortunately the nipple might flatten and shrink again after a while.

Another way is for women with large nipples. This technique is not used very often. Your surgeon can take tissue from the normal nipple and stitch it onto the reconstructed breast. This gives the most realistic appearance, although the new nipple doesn't flatten and both nipples are smaller than before.

The sensation in the normal nipple is usually unaffected.

Stick on nipple 

You can get stick on nipples if you don't want to have surgery. First you have a mould made from the nipple on your other breast. A technician fills the mould with latex to make a stick on nipple that closely matches your natural one.

You stick the nipple on every day. The nipple is easy to take off for washing, but the glue is good enough to keep it in the right place all day.

There are advantages to the latex nipple. It is very realistic and closely matches your real one. And you don’t need any more operations. The disadvantages are that you have to put it on every day and it may not stay put. The glue can be a bit sticky and messy.

Surgery to your other breast

Your surgeon aims to make your new breast match your other breast as closely as possible. But this might not be possible unless you have surgery to the other breast.

About 1 in 3 women having reconstruction need surgery to their opposite breast to do one of the following things:

  • make it bigger to match the new breast
  • make it smaller to match the new breast
  • tighten it up so it doesn’t droop more than the new breast

The after effects of each operation are different. So you will need to ask your own surgeon how your operation will affect you.

Making the breast bigger

To make your other breast bigger, the surgeon will put in an implant. You have a small scar that is difficult to see. This is usually in the skin fold under the breast.

Making the breast smaller or less droopy

After surgery to make the breast smaller or less droopy, you have scars on the breast. The position of the scars varies, depending on the technique your surgeon uses.

You might have a scar around the areola, a scar in the skin fold beneath the breast, and a vertical scar joining the two.

For more information, you can call the Cancer Research UK nurses on freephone 0808 800 4040 from 9am to 5pm, Monday to Friday.

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