Breast Reconstruction Options

If you’re thinking about breast reconstruction, it’s important to learn about the options and techniques available. Knowing your options can help you decide if breast reconstruction is right for you — in recovery and beyond.

Breast Reconstruction with Implants

Implants are devices filled with silicone or saline that help restore shape to your breasts after mastectomy. This type of breast reconstruction requires two or more surgeries and several visits after your initial surgery to prepare your body for the implants.

Surgery & Recovery

In the first stage of breast reconstruction with implants, a balloon-like tissue expander is placed under your skin or muscle. After you’re fully healed from this procedure, your Mercy surgeon injects saline into the tissue expander every week to stretch the skin or muscle.

In the second stage, the tissue expander is removed and replaced with a permanent breast implant.

Possible Complications

Potential risks with implant surgery include: 

  • Bleeding
  • Scarring that creates a hard tissue capsule (capsular contracture), resulting in pain or shape changes
  • Reaction to anesthesia
  • Rare risk of anaplastic large cell lymphoma, an immune system cancer
  • Differences in breast size or appearance (asymmetry)
  • Pain or changes in breast sensation
  • Deflation or rupture of the implant
  • Infection or problems with incisions healing
  • Need for future surgery to remove the breast implant

Other Considerations

You and your Mercy doctor should also discuss the following:

  • If you have larger breasts, you may need reduction surgery on the opposite breast to create a more even look.
  • If you’ve had radiation therapy to the chest, the skin and tissues needed for successful implant surgery may be affected.

Autologous Breast Reconstruction

In autologous (or flap) reconstruction, a tissue flap containing skin, fat, blood vessels and sometimes muscle is taken from another part of your body and used to rebuild the breast.

If you’re having flap reconstruction on only one of your breasts, your Mercy doctor may recommend genetic screening for breast cancer to find out if you’re at high risk of developing cancer in the opposite breast. If another breast reconstruction is needed later, surgical options are more limited because tissue can only be taken from the abdomen once.

Surgery & Recovery

Flaps used for breast reconstruction often come from your abdomen or back, but they can also be taken from your thighs or buttocks. Depending on their source, they’re either pedicle or free flaps.

Pedicle Flap

With a pedicle flap, the flap stays connected to the body and is tunneled under the skin to the breast area. Since the blood supply remains connected, no microsurgery is required.

Free Flap

A free flap is disconnected from the body and blood supply, then moved to the breast area. Microsurgery is required to reconnect the blood supply.

Abdominal & Black Flaps

Types of abdominal and back flaps include:

  • DIEP flap – A free flap from the abdomen that contains skin, blood vessels and fat – but no muscle.
  • Latissimus dorsi (LD) flap – A pedicled flap from the middle and side of the back.
  • SIEA flap (also known as SIEP flap) – A free flap from the abdomen. It’s like a DIEP flap, but it includes a different set of blood vessels and doesn’t require cutting the abdominal muscle.
  • TRAM flap – This flap can be either pedicled or free, comes from the lower abdomen and includes muscle.

Thigh & Buttock Flaps

Flaps from the thighs or buttocks are used if you don't have enough abdominal tissue to reconstruct a breast, or you’ve had major abdominal surgery. These types of flaps include:

  • IGAP flap – Tissue comes from the buttocks and contains only skin, blood vessels and fat.
  • PAP flap – Tissue comes from the upper thigh and doesn’t include muscle.
  • SGAP flap – Tissue comes from the buttocks but includes a different set of blood vessels than used in an IGAP flap. The SGAP flap only contains skin, blood vessels and fat.
  • TUG flap – Tissue comes from the upper part of the inner thigh and includes muscle.

Possible Complications

Potential risks with autologous breast reconstruction include:

  • Necrosis (or tissue death) of transferred tissue due to insufficient blood supply
  • Infection or problems with wound healing
  • Bleeding
  • Seroma (fluid collection)
  • Pain or changes in breast sensation
  • Loss of sensation from tissue removal
  • Reaction to anesthesia
  • Differences in breast size or appearance (asymmetry)

Other Considerations

You and your Mercy doctor should also discuss the following:

  • If you need radiation therapy to the chest after breast reconstruction, it can create complications with flap surgery.
  • Transplanted tissue needs an adequate blood supply to survive. If you smoke or have diabetes, vascular disease or connective tissue disorders, you’re at higher risk for complications with flap surgery.

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