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Types of breast reconstruction

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This page gives basic information about the main types of breast reconstruction. There is information about

 

A quick guide to what's on this page

Types of breast reconstruction

There are three main options for breast reconstruction. You can have

  • An implant put in to replace all or some of your breast tissue
  • A breast shape made from your own body tissue
  • A combination of implant and body tissue reconstruction

All the reconstruction methods create a smooth breast shape with no nipple. There are benefits and drawbacks for each type of reconstruction. This is something you can talk to your plastic surgeon or breast care nurse about.

Recreating a nipple

If you want to have a new nipple made, there are a few options. You could have

  • A tattoo to darken the area where the nipple would be
  • A new nipple created from your own body tissue or the opposite nipple
  • A stick on latex nipple made from a cast of your remaining nipple. 

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

Surgery to your other breast

Your surgeon will aim to make your new breast match your other breast as closely as possible. But about 1 in 3 women need surgery to their opposite breast to make it match their new one more closely.

 

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Types of breast reconstruction operation

 

How to choose

There are benefits and drawbacks to all types of reconstruction. This is something you can talk about with your breast or plastic surgeon, or breast care nurse. There may 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 reconstructions

  • Are the simplest to do
  • Cause the least scarring
  • Give a reasonable shape for small or medium sized breasts
  • Don't change in size if you gain or lose weight
  • Are more likely to have long term problems because the implant is a foreign body
  • Feel less natural, colder and less mobile than a body tissue reconstruction
  • Are not advisable if you are going to have radiotherapy afterwards
  • May not be possible if you have had radiotherapy or don’t have healthy chest wall skin
  • May 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 – they are more likely to need further surgery than body tissue reconstruction

Body tissue breast reconstructions

  • Give a breast that is warm, soft and feels natural
  • May avoid the use of implants
  • Can usually be done in one or two operations
  • Are much bigger operations than implant reconstruction
  • Leave you with two wound sites after surgery and two sets of scars
  • May give a higher chance of arm weakness (with latissimus dorsi reconstruction)
  • The reconstructed breast tends to droop after some time so the breasts may be out of alignment

Body tissue reconstructions with abdominal tissue (a TRAM flap or DIEP flap)

  • Give you a flatter tummy
  • Will lose or gain weight as you do
  • May not be possible if you already have surgical scars on your abdomen
  • May need surgery to the opposite breast to make a good match

Body tissue reconstructions with back tissue (a latissimus dorsi flap)

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

Recreating a nipple

All the reconstruction methods create a smooth breast shape with no nipple. If you want to have a nipple made, there are a few options. You could have a

All the options create the appearance of a nipple. But it 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 tattoo

You can just have a nipple shape tattooed on, with no surgery. This will not give you any sign of a nipple through clothes. One lady who had nipple tattoos recently contacted us to share her experience

"Following my double mastectomy two years ago I decided
that I would like nipple tattoos rather than nipple reconstruction.
I was offered this procedure at the hospital but they
were very honest with me and said that a
tattoo artist would do a better job. I found a
female tattoo artist who was very compassionate. I had the
tattoos done and I am extremely pleased, they look so
real, the detail is incredible and it has
made me feel great"

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 may not end up in the right place.  

Your surgeon can create a nipple shape from body tissue in one of two ways. If you have large nipples the surgeon can take tissue from the other normal nipple and stitch it onto the reconstructed breast. This gives the most realistic appearance, although the new nipple doesn't flatten. The sensation in the normal nipple is usually unaffected. 

The other way of creating a nipple 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 after your nipple has been made, 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 will gradually flatten and shrink until they are just about gone. The surgery can be done again, but unfortunately the nipple may flatten and shrink again after a while.

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. 

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

After surgery to make the breast smaller or less droopy, you will have scars on the breast. The position of the scars varies, depending on the technique your surgeon uses. You may have a scar around the areola, a scar in the skin fold beneath the breast and a vertical scar joining these two.

 

Finding out more about breast reconstruction

This basic information about breast reconstruction may have raised a lot of questions for you. It may help to make a note of them. Find out as much as you can about breast reconstruction before your surgery.

The best place to get information is from your breast surgeon, plastic surgeon or breast care nurse. They can show you photos so that you can see what the likely result of your surgery will be.

If you would like to get more information about breast reconstruction from elsewhere, contact one of the breast cancer information organisations. There are books and booklets about breast reconstruction, some of which are free. You can find details of books and booklets on our breast cancer reading list

You can also contact the Cancer Research UK information nurses. They will be happy to help.

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Updated: 17 October 2012