David Ross and his team at St Thomas’ Hospital, London have lead much of the advancement of TRAM Flap reconstruction techniques. Muscle and fat are removed from the stomach area and placed into the breast area. Sometimes it is possible for the blood supply to the stomach area to be preserved. When it is not, blood vessels from the stomach tissue must be attached to the chest area using microsurgery.

Implant Based Reconstruction

During the mastectomy, the surgeon removes skin and breast tissue, leaving the breast tissues flat and tight. Before a permanent implant can be inserted the skin of the breast needs to be stretched to make a space. This process is called tissue expansion and is performed in 1 or two stages.

• Two-Stage Reconstruction

This is a very popular option. The surgery can be performed as a delayed or immediate procedure.

A temporary tissue expander is placed within the chest. Over a period of weeks the expander is filled with saline causing the skin to gradually stretch and grow to make room for the implant as it expands. Once the right size has been reached the expander implant can be replaced with a permanent silicone implant.

• One-Stage Reconstruction

The surgery occurs initially in the same way as the two-stage procedure. However, the implant used is a permanent silicone implant with an expander facility. The device has a small fill tube and dome that is placed near the implant. Over a period of weeks or months the implant is expanded with saline. When the desired size is reached the tube and port can be removed leaving the implant in place.