Breast reconstruction aims to create a breast that resembles a natural breast in appearance and form. This is done by using the woman's own tissues or an implant.

The types of reconstruction that are suitable for a woman depend on a number of factors including what the woman wants, the nature of her tumour and other treatments she requires after surgery such as chemotherapy or radiotherapy.

Reconstruction can be done at the same time as the mastectomy - immediate reconstruction, or sometime after the cancer surgery - delayed reconstructuion.

There are 3 main types of reconstruction for a complete mastectomy.

Expander/Implant: This usually requires two operations. The first inserts an empty silicone bag under the skin and muscle where the mastectomy has removed the breast tissue. The silicone bag is then inflated over 2 months and then replaced by a permanent implant in the second operation

Tram Flap: This uses tissue from the lower abdomen to recreate the breast and only uses the woman's own tissue.

Latissimus dorsi reconstruction: Skin and muscle are taken from the back to create the breast. This method usually requires an implant to be used as well.

Recovery after breast reconstruction varies between the different procedures used.
Written by Mr. Stephen Mills

Reconstruction of Congenital breast defects

Breast growth begins at an average age of about 11 years, but there is a wide range of normal e.g. 8 - 15 years of age. It is usually complete by age 16 - 18.

Congenital breast deformities range from minor to major. A simple classification is :

NIPPLE deformities

• Extra nipple
• Absence or underdeveloped nipple
• Inversion

BREAST deformities

• Absence of the breast ( 1 or both)
• Normal shape: symmetric and asymmetric
  • Underdeveloped
    • Small breast
  • Over developed
    • Juvenile hypertrophy
    • Accessory breast
• Abnormal shape: symmetric, asymmetric
  • Constricted breast, tuberous breast
  • Polands syndrome
• Gynaecomastia (breast development in boys)

Treatment: surgery is usually begun once breast development is thought to be complete. For nipple deformities it may involve a small procedure under local anaesthetic.

However, for more major problems the plastic surgeon must select from a range of techniques to reconstruct one or both breasts. The goal is to create a breast with a natural shape and proportion which is pleasing to the patient.

Example of a tuberous breast deformity. This is a complex problem which is usually asymmetric. The affected breast will have a narrow base, small volume, a high inframammary crease (crease below the breast), herniation of tissue behind the areola, and insufficient skin.

Reconstructive surgery is often done in stages, using tissue expanders and implants. Sometimes "flaps" are used such as the LD flap from the back, combined with an implant. The LD flap is also used in breast reconstruction for breast cancer patients.

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