Listed below are some of the types of surgery that can be used for breast reconstruction. These are explained more fully in the following pages:

• Breast reconstruction using an implant only. The implant is placed under the chest wall muscle.

• Using a flap of muscle, fat and skin from the back with or without an implant to supplement it. The muscle in the back that is used is called the latissimus dorsi. The flap (known as the LD flap) is tunnelled through the side of the chest to create the reconstructed breast but it stays connected to its original site at one end so that it keeps its blood supply. This is known as a pedicled LD flap.

• Using a flap of muscle, fat and skin from the abdomen. Usually an implant is not needed using this type of flap. The muscle in the abdomen that is used is called the transverse rectus abdominis. The flap (known as the TRAM flap) is tunnelled upwards from the abdomen beneath the skin, staying connected at one end for the blood supply. This is known as a pedicled TRAM flap.

• Using a TRAM flap as above, but as a free flap instead of a pedicled flap. This means that the blood supply is cut and a new blood supply is created at the area of the breast. This is known as a free TRAM flap.

• Using a TRAM flap where a flap of skin and fat only (no muscle) is taken from above the transverse rectus abdominis muscle with a branch of the main blood vessel for its blood supply. This is known as a free perforator TRAM flap or a free DIEP flap (because the blood vessels used are the Deep Inferior Epigastric vessels). Other types of perforator flaps (taken from other areas of the body) are mentioned later in the section on free perforator flaps.