Breast reconstruction

Breast reconstruction is surgery to create a new breast after mastectomy. The aim of breast reconstruction is to restore the natural appearance and feel of your breast.

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For many women, breast reconstruction is an important step in their emotional and psychological recovery from breast cancer. It can also prevent the need for an external prosthesis and make it easier to wear certain clothes like bras and swimsuits.

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Breast reconstruction can be done at the same time as mastectomy (known as immediate breast reconstruction) or months or years later (delayed breast reconstruction). Techniques include:

• Using tissue taken from another part of your body (autologous or "flap" reconstruction)

• Implants.

• A combination of both.

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Autologous reconstructions use your own tissue and produce a warm, soft, and pliable breast. They are considered the gold standard for breast reconstruction because they give the most natural look and feel. The results are long-lasting, and your breast will age naturally with you.

Implant-based reconstructions involve shorter surgery and recovery, but the implants are likely to need replacing in time (see implant exchange for more information).

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We’ll discuss all the options in detail, to help you choose the best approach for you.

Autologous breast reconstruction: DIEP and TUG flaps

Autologous breast reconstructions, which are the gold standard technique for breast reconstruction, use tissue from your tummy (DIEP flap) or inner thigh (TUG flap):

• DIEP flap: uses skin and fat from your lower abdomen (similar to that removed in a tummy tuck) to create a new breast, with the added benefit of giving you a flatter abdomen afterwards.

• TUG flap: tissue from your upper inner thigh is used, leaving a discreet scar under your groin crease. The TUG flap is a good option for women who don’t have enough abdominal tissue for a DIEP flap, or who prefer a different donor site.

In these procedures, the tissue from your tummy (DIEP) or thigh (TUG) is carefully detached, along with the blood vessels that supply it. It is then shaped, moved up to your chest, and the blood vessels are connected to vessels in your chest or armpit, using a microscope. This enables the tissue to survive in its new location.

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Both autologous reconstruction options involve microsurgery and a longer recovery, but offer excellent, natural-feeling results. Because your reconstructed breast is made from your own tissue, the results are long-lasting, and your breast will age naturally with you.

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Your new breast will also be able to withstand the effects of radiotherapy better than an implant, should this be recommended for you after your surgery.

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Autologous breast reconstruction is a major operation, typically lasting six hours, and is only performed at select NHS or private hospitals. I specialise in these techniques and perform around 80 of these operations each year.