Autologous Tissue With Implant Breast Reconstruction
This type of breast reconstruction requires the use of a smaller tissue expander/implant with your own tissue because of the limited volume of your back tissue.
Latissimus Dorsi Flap
This flap borrows muscle and skin from the upper back. The tissue, while still partially attached to the body, is tunneled underneath the skin from the back to the chest. Although this method provides much of the needed skin, there is not enough tissue volume to form the breast mound by itself. Therefore, either a tissue expander or implant can be used to stretch the transferred muscle and skin from the back. At a later stage, the tissue expander is replaced with a permanent implant. This procedure is most commonly performed if you have had a mastectomy on one of your breasts followed by radiation and do not meet the criteria for a TRAM or DIEP flap. This procedure is not recommended if you perform a lot of repetitive or strenuous overhead activities with your arms.
Matching the opposite breast (optional)
A reconstructed breast will not precisely match your natural breast. If you have large breasts, you may need a reduction of your opposite breast in order to match the reconstructed breast. If you have smaller breasts that sag, you may need a lift of the natural breast or augmentation with an implant to improve the shape and facilitate symmetry. Both reductions and lifts leave permanent scars on your breasts. The precise location of the scars and technique used to balance the breasts will be explained in great detail by your plastic surgeon when planning for this stage.
Reconstruction of the nipple and areola (optional)
It is preferable to allow your reconstructed breast to "settle" for at least 3 months so that the nipple and areola can be placed in the proper position. Nipple/areola reconstruction is done as an outpatient surgery, usually only with local anesthesia. This procedure usually involves very little discomfort.
The nipple may be made from the tissue and fat of the reconstructed breast. If the nipple of your natural breast is prominent, then a portion of it can be used as a graft to make a new nipple for the reconstructed breast in a procedure called "nipple share". The nipple may also be made using a small wedge taken from the labial region especially in patients where there may be undesirable redundant labial tissues. The areola can be made from a skin graft taken from your abdominal scar (if you had a TRAM/DIEP) or from your inner thigh crease.
The finishing touch in nipple/areola reconstruction is a tattoo procedure to match the colour of your natural nipple and areola. This can be done either in a minor procedure room or by a medical tattoo artist several months following the nipple/areolar reconstruction.