Other Reconstructive Options
Implant-based reconstruction restores the breast shape using a silicone implant after mastectomy. It involves a shorter operation and recovery than reconstruction using tissue from another part of the body. There are two main approaches:
Direct-to-implant reconstruction
In direct-to-implant reconstruction, the permanent breast implant is inserted at the same operation as the mastectomy. This is a single-stage procedure and avoids the need for expansion and a planned implant-exchange operation.
It is most suitable when the breast skin is healthy, has a good blood supply and can safely accommodate the chosen implant. Further surgery may still be required to improve symmetry or revise the reconstruction.
Two-stage expander reconstruction
In a two-stage reconstruction, a temporary inflatable tissue expander is placed at the time of mastectomy. The expander is gradually filled with saline during outpatient appointments, allowing the breast skin and tissues to stretch progressively.
Once the desired volume has been achieved and treatment is complete, the expander is replaced with a permanent silicone implant during a second operation. This approach provides greater control over breast size and skin expansion and may be preferable when the tissues are tight or their blood supply is uncertain.
Both approaches may use a biological or synthetic mesh to support the implant. The most appropriate option depends on your anatomy, breast size, tissue quality, cancer treatment and whether radiotherapy is anticipated.
The steps involved depend on which option is most appropriate for you. Broadly, these fall into two approaches:
Implant-Based Reconstruction
This may be performed in one stage (a permanent implant placed at the time of mastectomy) or two stages (a temporary tissue expander is placed first and gradually filled over several weeks or months, before being exchanged for a permanent implant).
Latissimus Dorsi (LD) Flap
A section of the latissimus dorsi muscle, together with overlying fat and skin, is moved from the back to the chest, still attached to its blood supply, to recreate the breast mound or to add soft tissue coverage.
LD Flap with Implant
The LD flap is often combined with an implant beneath it, using your own muscle and skin to provide healthy soft tissue coverage while the implant provides most of the volume.
Shaping and Symmetry
Whichever technique is used, the reconstruction is carefully shaped, and further procedures such as fat grafting, symmetrisation surgery on the opposite breast, or nipple reconstruction can be planned at a later stage.
Who is it for?
Implant-based or LD flap reconstruction may be a good option for you if:
You do not have enough donor tissue at the abdomen or thigh for a DIEP, TUG or PAP flap, or you are not fit for a long microsurgical operation.
You would prefer a shorter operation and generally quicker initial recovery, and are comfortable with the trade-offs of using an implant.
You need additional healthy soft tissue coverage, for example after radiotherapy, and an LD flap can provide this even where a full autologous reconstruction is not suitable.
You are undergoing bilateral (both-sided) reconstruction and want to avoid using donor sites elsewhere on the body.
You understand and accept the possibility of future implant-related surgery, such as exchange or revision.
Before & After
Coming soon
Before-and-after photographs are shared only with each patient’s consent. Examples will be added here in due course — in the meantime, Dr Borges is happy to discuss expected results at your consultation.
Scarring for implant-based reconstruction is generally limited to the mastectomy scar on the breast itself. An LD flap adds a further scar on the back, typically positioned so it can be concealed by a bra strap or swimwear where possible. All scars are usually firm and pink initially, softening and fading over 12–18 months.
What to expect
Recovery varies depending on the technique used, but is generally shorter than after a microsurgical flap reconstruction.
In Hospital
Most patients spend 1–3 nights in hospital, depending on whether an implant, expander or LD flap has been used, with pain and wound care carefully managed throughout.
First 2 Weeks
Rest and a supportive bra are important. If a tissue expander has been used, gradual expansion visits typically begin a few weeks after surgery once the wound has settled.
2–4 Weeks
Most women return to light office work within 2–4 weeks. Back stiffness after an LD flap usually settles gradually over this period.
Beyond 4 Weeks
A gradual return to sport and exercise is possible from around 6 weeks. If an expander-to-implant approach is used, the exchange to a permanent implant is usually planned once expansion is complete, often several months after the first operation.
Why choose this procedure
Advantages of implant-based or LD flap reconstruction can include:
Shorter surgery and recovery
Generally a shorter operation and quicker initial recovery than microsurgical flap reconstruction.
No distant donor site (implant-only)
Implant-based reconstruction avoids creating a second surgical site elsewhere on the body.
Suitable when flap options are limited
Can be a good option for women without sufficient donor tissue, or who are not fit for a lengthy microsurgical procedure.
Good option for bilateral reconstruction
Can achieve balanced, symmetrical results on both sides without using donor tissue twice.
Additional soft tissue coverage where needed
An LD flap can provide healthy, well-vascularised tissue in areas affected by previous radiotherapy or thin skin.
Established, well-understood techniques
Both approaches have a long track record and predictable recovery pathway.
Risks
As with all breast reconstruction, implant-based and LD flap techniques carry risks, which I will discuss with you in detail before surgery. These include:
Capsular contracture
Tightening of the scar tissue around an implant, which can alter the shape or firmness of the breast and occasionally requires further surgery.
Implant complications
Rupture, leakage, malposition or visible rippling of the implant over time.
Need for future surgery
Implants are not designed to last a lifetime and may need to be exchanged or revised in the future.
Infection
Infection around an implant or flap, which occasionally requires implant removal.
Animation deformity (LD flap)
Visible movement or distortion of the reconstructed breast when the back muscles are used, as the latissimus dorsi remains partly functional.
Effect of radiotherapy
Previous or planned radiotherapy can increase the risk of capsular contracture and other complications with implant-based reconstruction.
Asymmetry
The reconstructed breast may not perfectly match the natural breast, and further surgery may be recommended to improve symmetry.
As reconstructive procedures following breast cancer treatment, implant-based and LD flap reconstruction are typically eligible for NHS funding and are recognised by most private medical insurers. Costs for private treatment vary depending on the technique and individual circumstances, and will be discussed and quoted following your consultation.
Book a ConsultationLocations
Consultations and surgery take place at accredited hospitals and clinics across Kent and London, with consultations available in English, Portuguese and Spanish.
Nuffield Health Tunbridge Wells Hospital
Kingswood Road, Tunbridge Wells, Kent, TN2 4UL
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Wells Health, Fordcombe Hospital
Fordcombe Road, Fordcombe, Tunbridge Wells, Kent, TN3 0RD
Google Map →Wells Health, Tunbridge Wells Hospital
Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ
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