I deal with a lot of breast reconstruction from prophylactic mastectomies, preservation of the entire skin and nipple areola complex to immediate mastectomies with preservation of the skin and nipple areola complex to Patey mastectomies where some skin and the nipple is sacrificed. Depending on the contralateral breast, and the patient's wishes there are various options. These options include immediate implant reconstruction, a two-stage breast reconstruction with tissue expansion as the first stage and exchange of the expander for a definitive implant as the second stage. The lower abdominal fat can be used to reconstruct breasts. This is often thought of as the gold standard in breast reconstruction. It can give a ptotic and soft breast. This technique has evolved from a pedicle flap where the tissue is tunneled underneath the upper abdominal skin into the chest area. This was initially described by a plastic surgeon in Atlanta, USA, Dr Carl Hartrampf in the 1970's.

Following this, the free TRAM flap became popular with the advent of microsurgery. The blood supply of the free TRAM flap is often better than the pedicle flap but one rectus muscle has to be sacrificed. This does not appear to significantly weaken the abdominal wall for everyday use. The last ten years has seen the advent of perforator flaps evolve. This means that the muscle does not have to be sacrificed and can be left intact in the abdomen. The perforating vessels are dissected through the muscle. I have used this technique over the past eight years with excellent results. The procedure itself is a little longer, more challenging and more demanding. I usually perform these operations with another plastic surgeon and thus can give the benefit of an aesthetic breast as well as an aesthetic abdomen as in a tummy tuck.