Breast reconstruction involves recreating a breast mound after the breast has been removed for cancer. This can best be accomplished at the time of the mastectomy, although delayed reconstruction can still lead to satisfactory results.

There are two options when considering reconstruction: implant or autologous (the patient’s own tissues). Implant reconstruction involves the use of a water filled prosthesis placed under the muscle of the chest wall. The skin is gently expanded during the months following the mastectomy until sufficient volume is reached to match the remaining breast.

Autologous reconstruction involves the use of a woman’s own tissue from her abdomen, back, or buttock to re-create a breast mound. The “flap”, depending on where it is taken from, is either tunneled to the breast area under the skin, allowing it to retain its original blood supply or it is surgically removed (free flap) and reattached in the chest area using microsurgery. The TRAM flap (transverse rectus abdominous myocutaneous flap) is by far the most common of these autologous procedures. It involves the use of the tissues of the lower abdomen that would normally be discarded during a “tummy tuck”.

Advantages and disadvantages exist in both types of reconstructions, the implants being a shorter operation with faster recovery but yielding results that often lack symmetry, especially if the opposite breast has any amount of droop. The implant reconstructions are also more likely to require subsequent revisions since they do involve the use of foreign material. The TRAM reconstruction does require four to six days of initial hospitalization and four to six weeks of recovery time, as well as abdominal discomfort that would otherwise not be felt with an implant. However, the eventual contour that is obtained is far superior, including a tight abdomen and a more natural soft breast mound that is created in one stage.