in the operating theatre:

MeThodS of ReconSTRUcTIon
Implant-based reconstruction is a popular choice that uses an implant to rebuild the breast. A deflated, expandable implant is placed under the chest muscle and small amounts of a salt water solution are injected every few weeks until the desired breast size is reached. A second surgery removes the expandable implant and replaces it with a permanent one, either silicone or saline. Small-breasted women with little abdominal fat are the best candidates for this type of reconstruction. Women who have had radiation therapy on their chest are usually not good candidates, as the skin can be too damaged to stretch.

Autologous reconstruction uses skin, fat and muscle from the body; includes DIEP, SGAP, TRAM and TUG

dIeP flap The Deep Interior Epigastric Perforator flap is microsurgery suitable for patients with sufficient stomach fat 3. New skin flap is attached to internal mammary vessels, which will nourish the flap.

1. Skin, fat and blood vessels removed from the abdomen, leaving the muscle in place to preserve abdominal strength and speed up recovery time. SGAP or IGAP flap spare the muscle, using only skin, fat and blood vessels from the upper or lower buttock to build a new breast. A surgeon uses a microscope to reconnect even the tiniest blood vessels. SGAP uses tissue from the upper part of the buttock, while IGAP uses tissue from the lower buttock.

2. The DIEP flap transports the deeper blood vessels that run below and within the abdominal muscle.

New nipple and areola created at a later stage

TUG flap is microsurgery which uses skin, fat, blood vessels and some muscle from the patients inner thigh to create a new breast.

TRAM flap surgery uses muscle, skin, fat and blood vessels from the abdomen. The procedure can either be a pedicled flap, where the tissue is tunnelled under the abdominal skin to the chest and keeps its original blood supply, or a free flap, where the tissue is completely removed and reconnected through microsurgery.

Latissimus dorsi flap uses muscle, fat and skin from the patients back to create a new breast. If the patient has large breasts, the surgeon may use an implant as well to more closely match the size of the remaining healthy breast. Women who arent candidates for the TRAM and DIEP flap are the best candidates. However, active women who take part in activities using the shoulder muscles, like swimming, tennis, or rowing are not good candidates.

Illustrations courtesy Center for Restorative Breast Surgery Graphic: Darren Francey, Calgary Herald