Types of Breast Reconstruction

Reconstruction of the breast falls into two main categories: implant-based and tissue-based reconstruction. With all reconstruction surgery, there are follow-up procedures to build or better define a nipple, as well as to refine the breast shape and to address any incisional scarring. The Vanderbilt Breast Center offers several types of plastic surgery operations that can be done to reconstruct a patient’s breast after a mastectomy. These include: expander/implant reconstruction as well as patient tissue reconstructions. The tissue reconstructions include the TRAM flap (abdominal tissue) or tissue from the back, buttock or inner thigh. The Vanderbilt Department of Plastic Surgery also performs the Deep Inferior Epigastric (DIEP) Reconstruction. For patients interested in non-surgical options for breast reconstruction, Pretty in Pink Boutique, adjacent to the Breast Center, offers prosthetics and provides a personal fitting with a registered nurse.

Implant-based reconstruction is typically done in stages. There is often not enough room to add an implant after a mastectomy, so tissue expanders are inserted below the skin and a chest muscle known as the pectoralis major. The balloon-like expanders have a port through which saline is added gradually over several weeks until the skin of the chest is stretched enough to accommodate implants. Then a second surgery is done to insert implants. Minor procedures then follow to refine the breast area.

Tissue-based or autologous reconstruction uses skin fat, and sometimes muscle, usually from another area on the body to form a breast shape. The tissue that is used, called a “flap,” can come from the belly, the back, buttocks or inner thighs. If the tissue is completely separated from its original blood vessels and moved, it is called a “free flap.” If the tissue remains attached to its original blood vessels and moved under the skin to the chest area, it is known as “pedicled flap.”