• Very rare indications = Bilateral/unilateral mastectomy + Small breasts + Unlikely to have post-operative radiotherapy + Good skin condition at the end of the mastectomy

• A definitive breast implant will be inserted underneath the skin or muscle

• Majority of patients with a low risk of having post-operative radiotherapy

• An inflatable breast implant is inserted underneath the muscle and left deflated

• After 2 weeks of uneventful wound healing, the expander is inflated around 60-100 cc per week, to the desired volume

• After 4-6 weeks, the expander is exchanged for a definitive breast implant

• Women with high risk of post-operative radiotherapy as this options preserves the native breast skin and minimizes unaesthetic scarring

• An inflatable breast implant is inserted underneath the muscle and marginally inflated

• After 2 weeks, pathology reports will dictate the need for radiotherapy.

• If no radiotherapy indicated, definitive reconstruction with implants or flaps is undertaken

• If radiotherapy is indicated, the expander is left deflated through chemotherapy and radiotherapy plus 4 weeks recovery where the expander is inflated until the desired volume over 3 months and definitive reconstruction with implants or flaps is undertaken

• Usually used in patients with prior radiation therapy and damaged skin or as a salvage option

• Pedicled flap (no microsurgical transfer)

• The incision line is hidden in the bra line in the back

• Skin and muscle are rotated in the breast and an implant or fat is used for volume

• No muscular deficit except in athletes and climbers

Click for Latissimus dorsi illustration

• Used in patients who already need moderate to large volume breasts

• No past history of liposuction, abdominoplasty or open abdominal surgery

• Free flap = the skin and fat of the lower abdomen are harvested with its vessels and connected under a microscope to the vessels around the breast

• Scar is hidden under the bikini line in most cases

• The most natural feel across all reconstructive options

Click for DIEP Illustration

• Used in patients who already need small volume breasts

• The procedure of choice in patients with contraindications to a DIEP flap

• Free flap = the skin and fat of the inner thigh are harvested with its vessels and connected under a microscope to the vessels around the breast

• Scar is hidden in the inner thigh fold but can cause some aesthetic contour deformation