Breast Reconstruction

The diagnosis of breast cancer can have a potentially devastating physical and psychological effect on a woman. Mr Rayatt works closely with the breast cancer team and is able to offer the full range of techniques available for breast reconstruction. This includes implant based reconstruction (implants only or implants combined with a skin and muscle flap) and autologous reconstruction (avoiding implants and using patients own tissue). This can be done at the time of the cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction). Reconstruction involves replacement of the tissue removed, which are skin and breast tissue.

Implant Only

This is the simplest type of reconstruction and gives a breast mound which looks good in clothing. The implant is used to stretch the skin and give volume and is usually placed underneath the skin and muscle of the chest.

The advantages of this technique are the speed of the surgery (1-2 hours), short hospital stay (1-2 days) and short recovery time (2-4 weeks). This technique is best suited to patients with smaller breasts because it can be difficult to match larger more ‘droopy’ breasts, and surgery may be required to the opposite breast in the form of a reduction or a lift to gain the best match. For those needing bilateral mastectomy, symmetry can be excellent. For some patients who have had, or need to have radiotherapy treatment, this form of reconstruction is usually not recommended as the risks of complications are increased.

Latissimus Dorsi Muscle Flap & Implant

Skin and tissue can be replaced by tranferring muscle and skin from the upper back to the front of the chest. The latissimus dorsi muscle is a broad muscle on the back that is a reflection of the front chest muscle. It can be used to make a modest sized breast (‘B’cup) or with the addition of an implant, it can be used to create a larger breast. This can give a very nice natural looking breast.

This procedure takes about 3-4 hours, involves a hospital stay of about 5-7 days, and recovery time of about 4-6 weeks. The risk of the transferred tissue not surviving is low (< 1%). The patient is left with a scar on the back, in line with the bra strap Although this technique gives a very nice breast shape, but the opposite breast may still need reshaping for symmetry.

TRAM/DIEP Flap

To avoid an implant, the whole breast can be reconstructed using patients own tissue. The tummy tissue is ideal for this as it most closely resembles breast tissue in terms of skin and feel and the resulting hidden scar resembles a tummy tuck scar. With this technique the skin and fat of the lower abdomen, together with its artery and vein, is removed, transferred to the chest, and reattached. The small blood vessels in this tissue have to be re-connected to blood vessels in the chest using microsurgery techniques.

The blood supply of the tummy skin and fat travels up from the groin, passes under the rectus muscle (‘six-pack’ muscle) and passes to the skin through this muscle. When a portion of the rectus muscle is taken with the blood vessels, this is called a TRAM (Transverse Rectus Abdominus Myocutaneous) flap. Where possible the blood vessel can be traced through the muscle, avoiding damage to the muscle, to perform a DIEP (deep inferior epigastric perforator) flap. This technique, which helps speed recovery and prevents possible weakness and bulging of the abdomen, is considered to be the 'gold standard'. The procedure however takes longer (6-8 hours), hospital stay is 5-7 days, and recovery time is 4-6 weeks.

This method gives the most natural feel and look, however the risk of the procedure failing is about 5%.