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Navigating the World of Reconstructive Breast Surgery: A Comprehensive Guide

Updated: Sep 8, 2023

Reconstructive breast surgery is a transformative procedure that aims to restore the natural shape, size, and appearance of a breast following a mastectomy, lumpectomy, or congenital deformity. Through the skill and experience of consultant plastic and reconstructive surgeons like Dr. Damir Kosutic, patients can achieve a renewed sense of wholeness and confidence in their bodies

There are several techniques available for reconstructive breast surgery, each with its unique approach and advantages. The two primary methods are implant-based reconstruction and flap-based reconstruction, which can be further categorised into subtypes depending on the specific surgical techniques used. Factors such as the patient's anatomy, lifestyle, preferences, and the extent of breast tissue removed during the initial procedure can influence the choice of reconstructive technique.

In this comprehensive guide, we will explore various options in reconstructive breast surgery, discuss the benefits and potential risks involved in these procedures, and gain insight into the expectations surrounding the surgery and recovery.

Implant-Based Reconstruction: Restoring Breast Shape with Prosthetics

Implant-based reconstruction is a commonly used technique in breast reconstruction that involves inserting a saline or silicone implant to restore the breast's natural shape and volume. This method typically includes two stages: the first stage involves the placement of a tissue expander, which gradually stretches the skin and muscle to accommodate the final implant. The second stage involves replacing the tissue expander with a permanent breast implant.

Some advantages of implant-based reconstruction include shorter operative times, a quicker recovery period, and less scarring compared to flap-based techniques. However, this method may not be suitable for patients who have undergone radiation therapy due to skin elasticity concerns, or for those seeking a more natural look and feel. Your plastic and reconstructive surgeon will determine if implant-based reconstruction is an appropriate option based on your unique circumstances and preferences.

Flap-Based Reconstruction: Utilising the Patient's Own Tissue

Flap-based reconstruction involves using the patient's own tissue, harvested from other areas of the body – such as the abdomen, back, or buttocks – to recreate the breast mound. There are several flap techniques available, including:

1. **TRAM Flap:** Transverse Rectus Abdominis Myocutaneous (TRAM) flap involves using the skin, fat, and muscle from the lower abdomen to reconstruct the breast. The tissue is either left attached to its original blood supply (pedicled TRAM flap) or is completely detached and reconnected using microsurgery (free TRAM flap).

2. **DIEP Flap:** Deep Inferior Epigastric Perforator (DIEP) flap is a more advanced technique that involves the transfer of skin and fat from the lower abdomen while sparing the underlying muscle. This approach preserves abdominal strength, reduces postoperative pain, and offers a more natural-looking breast reconstruction.

3. **Latissimus Dorsi Flap:** This method utilises the skin, fat, and muscle from the upper back to reconstruct the breast. A latissimus dorsi flap may be combined with an implant if additional volume is needed.

Flap-based reconstruction provides a more natural look and feel compared to implant-based techniques, due to the use of the patient's own tissue. However, these techniques are more invasive, involving longer operative times, increased scarring, and longer recovery periods. A consultation with your plastic and reconstructive surgeon will help you determine if flap-based reconstruction aligns with your needs and desired outcomes.

Nipple and Areola Reconstruction: Completing the Transformation

For many patients, the final stage of breast reconstruction involves reconstructing the nipple and areola to create a natural-looking, finished result. Nipple and areola reconstruction can be performed using a variety of techniques, such as using local flap tissue or a partial-thickness skin graft to create the nipple, and tattooing for areola pigmentation.

The timing and technique of nipple and areola reconstruction will depend on the patient's individual circumstances and preferences. Your plastic and reconstructive surgeon will discuss the options and provide guidance on the best approach to achieving a balanced, harmonious breast appearance.

Recovery and Adjustment: Embracing Your New Appearance

The process of recovering from breast reconstructive surgery may take several weeks, with each patient's healing timeline differing depending on factors such as the chosen reconstructive technique, age, and overall health. Following your surgeon's postoperative care instructions is crucial to ensure a smooth and comfortable recovery, including adhering to restrictions on physical activities, managing any discomfort with prescribed medications, and attending follow-up appointments as scheduled.

It is important to have realistic expectations regarding the final outcome of your breast reconstruction, recognising that the reconstructed breast may not have the same sensation or appearance as your natural breast. By embracing your new appearance and acknowledging the emotional and physical journey of breast reconstruction, you can cultivate a positive mindset and increased self-confidence moving forward.


Reconstructive breast surgery presents an opportunity for individuals to restore their natural breast shape and appearance following mastectomy, lumpectomy, or congenital deformity.

Through a comprehensive understanding of the available surgical techniques and the guidance of Damir Kosutic Plastic & Reconstructive Surgeon, you can make informed decisions about the most appropriate course of action to achieve your desired outcomes. Embracing the right surgical plan and maintaining realistic expectations are essential components on the journey towards a renewed sense of wholeness, confidence, and radiance. Contact us today for a consultation on breast reconstruction!

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