I’ve mentioned before how clueless I was before my breast cancer diagnosis. In my mind I imagined that if I needed a mastectomy it would mean remaining flat. It wasn’t until I was sitting in my surgeon’s office and he started to talk about possible types of breast reconstruction that it even occurred to me that this was an option.
So for those of you like me, here is a overview of the breast reconstruction methods often used. Note that I am not a doctor, so these descriptions are just for information only, to give you a starting point for your own research and discussion with your doctors. Most doctors will only offer some of these options, very rarely all of them.
Aesthetic Flat Closure
I know staying flat seems like you are choosing no reconstruction, so it goes against the topic of this post, but I believe opting for aesthetic flat closure is a form of reconstruction in itself. The aim is to create a neat and flat chest without excess skin, with or without nipples.
Often doctors will leave excess skin when asked to not do reconstruction, just in case there is a change of mind down the track. If you are adamant that you want to stay flat and will not waver, insist on aesthetic flat closure otherwise you make end up with a bumpy chest instead of a smooth one.
According to my surgeon, this is the most common of the types of breast reconstruction. It was also the route I chose.
While implants are the final result, there are often different ways in which this result is achieved, depending on which other treatments are required, especially radiation.
Radiation can cause damage to the skin, stopping it from stretching, and cause damage to the implants, so if radiation is required, the usual method of reconstruction includes expanders being placed at the time of mastectomy.
Expanders are also commonly used even if it is unknown if radiation will be required. They can be inserted completely deflated, or they may be partially filled with saline. They are then periodically filled to stretch the skin to the required size, creating a pocket for the implant.
Implants can be placed over or under the muscle. Which is chosen depends on many factors including body size (some surgeons prefer to go under the muscle with slimmer ladies), activity levels, even the surgeon’s preference can play a part.
Fat grafting is common with implants, but not always needed. This is when fat is taken from another part of the body (usually stomach or thighs) and used to reshape and smooth out any lumps or bumps.
Flap reconstruction refers to a variety of methods where skin, muscle and fat is taken from another part of the body and used to rebuild the breasts. This is often preferred as it means there is no foreign object placed in the body. It often gives a more natural result too.
The downside is that it is a much bigger surgery with longer recovery times as two parts of the body need to heal.
Not everyone is eligible for flap reconstruction, for a variety of reasons, such as not enough fat at the donor site, previous scar tissue (such as a caesarean scar), insufficient blood supply, if there are other medical conditions that could affect healing, for example.
The most common types of flap reconstruction are below. There are some other rarely used options available too if these do not suit. Of course discuss them with your surgeon for all the variations.
- TRAM – (Transverse rectus abdominus myocutaneous) Takes skin, fat and muscle from the stomach area
- DIEP – (Deep inferior epigastric perforator) Takes only skin and fat from the stomach area, no muscle
- Latissimus Dorsi – takes skin, fat and muscle from the back. Sometimes does as a scarless procedure where the flap is moved around under the skin rather.
- GAP – (Gluteal artery perforator) Skin and fat is taken from the buttocks
- TUG – (Transverse upper gracilis) Skin, fat and muscle is taken from the thigh area. Could also be called VUG or DUG depending on exactly which area is used.
- PAP – (Profunda artery perforator) Again the thigh is used, but this time only skin and fat, no muscle.
Goldilocks reconstruction is a lesser known method that is starting to catch on more as an option. You will likely need to search for a surgeon who will perform this as it may not be commonly offered.
This method is called Goldilocks because it is an in-between method. Fat that would normally be removed during a mastectomy is instead left in place to form a small breast mound. This is not an option if you want larger breasts, but does give a result that has a little more shape without too much extra reconstruction required.
While not a full breast reconstruction, reclaiming nipples can make a huge difference to some people, and can be added on to all of the above reconstructions at the end.
There are different methods of reconstruction. Some take skin grafts from other parts of the body, others simply use the skin already on the breast to create that bump.
Reconstructed nipples don’t have any sensation and they don’t “work” like nipples, they are purely for aesthetics.
Often the nipple reconstruction is followed up by tattooing to give colour to the areola area.
This is a new procedure that was not available to me when I had my reconstruction, but is certainly something at least worth considering.
Resensation is a micro-surgery technique that reconnects the nerves in the breast, to bring back sensation. It is most commonly used with flap reconstruction, but I did see something recently about it being available with implants, so perhaps that option is becoming available too.
For my Australian readers, Resensation is only very new here with two surgeons in Sydney being the first to offer it.
Have you joined a breast cancer support group on Facebook but been completely overwhelmed by some of the posts? It’s fantastic that these groups are an open forum and all sorts of questions, worries and issues are addressed, but sometimes they can be too much. In fact sometimes they can be downright scary.
If you would still like to join a support group on Facebook but not be faced with some of the scarier aspects when you don’t want to see them, come and join Positive Breast Cancer Stories. Here we share positive stories, celebrate milestones and encourage each other rather than deal with the technical information >>
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You might find these other posts useful
- Breast Cancer Myths You Need to Hear Today
- Things No-one Tells You About Having a Mastectomy
- Bilateral Mastectomy Pictures
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Hi Josie, I am from Tennessee, USA and I can’t tell you how much your story has helped me cope with my diagnosis of IDC. Thank you so much for sharing it.
I went to see a recommended plastic surgeon yesterday about implants. He was very kind as he told me Diabetics are not eligible for breast implants due to an infection rate of 100% for Diabetics. I was devistated as that was the way I had chosen to go. This morning I’m looking into other options such as the DIEP Flap. I had Open Heart surgery at this time last year. I was back to Ballroom dancing 12 weeks later. I heal well for a disbetic.
Today I’m doing more research; making lemonade from those lemons.
Thanks for sharing your story. It’s so hard when you cannot have the reconstruction you initially choose, but I hope DIEP works out really well for you. This might just be a blessing in disguise 🙂
Thank you for the information. I had latissimus and implants as I didn’t have enough fat for a flap. Anyway what the doctor didn’t tell me was I would be in pain everyday for the rest of my life. Not the reconstructed breasts but the back and rib area. Your body had to find ways to work around these now absent back muscles. My body never did. Physical therapy offered only temporary relief. It’s been 15 years, just have to keep pushing.
I’m so sorry to hear you are living with so much pain. That was the one type of flap surgery my surgeon briefly mentioned, but I was worried about that exact thing. It’s such. shame there are no guarantees with any of this. We just make the best decision we can at the time and hope it all works out. Best wishes, I hope something works for you soon.
Thank you so much for sharing your experiences. It’s been a godsend to read through your blogs since I’m at the beginning of my journey. All the best to you!
Thank you, and good luck with your treatment.