Obviously this is a massive topic so the following discussion is aimed at giving you general information and should be viewed as generic rather than specific to your circumstances. The preface to these comments are to remember that your plastic surgeon will be bound by the over-riding priority of your holistic care and this prioritises your cancer treatment above all else. To be honest the great advances in breast reconstructive results which we have been able to achieve are as a result of modifying breast mastectomy incisions and techniques such that more and more tissue is preserved.
There is no doubt that the overwhelming decision you need to make about the ultimate breast aesthetics depends on whether you have an immediate reconstruction or not. The best results by far are achieved with immediate reconstruction. The problem with a delayed reconstruction where the mastectomy is done first and the reconstruction done later is that the scarring is much worse and impacts the ability to achieve a good result. In most cases the more skin and nipple areolar complex that is preserved the better cosmetic outcome.
Autologous tissue is considered the gold standard reconstruction as it has many advantages over implants. It looks more natural, feels more natural, ages like the other breast and if all goes well it is much more durable and will last for a lifetime. It does have significant downsides and they are that it involves a scar elsewhere on the body (usually the abdomen) and a larger operation with a longer recovery.
The breast is reconstructed with a combination of skin and fat and this is usually taken from the skin between the umbilicus and the pubic region. The resultant scar is the same as a tummy tuck and for suitable women it is then a “2 for 1” procedure. These operations involve microsurgery and are technically much more difficult than implant reconstructions. The most common procedure is still the TRAM flap which involves taking the abdominal muscle whilst a newer innovation is called the free DIEP which preserves the muscle. The DIEP has the added advantage of reducing the complications of the abdominal donor site such as bulging or hernia formation and is quickly becoming the standard. With modern techniques and fine microsurgery the success rate is 99%.
For those who don’t have enough fat in this region, other sites can be used which are either the buttock or inner thigh.
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