Implants vs Autologous breast reconstruction – Which is best for you?
While there is no procedure that can restore the original feeling in the breast region following mastectomy and lumpectomy, recent advances in plastic surgery have increased the range of reconstructive options available to women. Breast reconstruction helps women who have just faced the scourge of cancer feel whole again and discover a new-found sense of confidence.
Plastic surgeons may use tissue obtained from the patient’s own body (flap reconstruction) or breast implants to perform a reconstruction. The decision on whether to carry out implant-based or autologous breast reconstruction should take into account the patient’s preferences. This article explores these alternative breast reconstruction options to help you make the right decision.
1. Breast implant reconstruction
Breast reconstruction with implants typically requires a two-part procedure. Immediately after the mastectomy, the surgeon will insert a tissue expander to temporarily create space underneath the skin and fat in the breast region. Months later, the expander is removed and replaced with a permanent implant. In rare cases, it is possible that this procedure is completed at the same time as the mastectomy. Of course, the surgeon will take into consideration the patient’s surgery and preferences to find the right approach.
Women can choose from two different types of breast implants:
- Silicone implants – these breast implants have a silicone shell that is filled with silicone gel. Silicone implants tend to maintain their shape and feel natural to the touch. They are approved by the Food and Drug Administration (FDA) for use by women who are older than 22. Because they usually do not deflate if they leak, women with silicone implants will need to undergo imaging tests (MRI) every other year to check if they are normal.
- Saline implants – this type of implant features a silicone shell that is filled with a salt-water solution. Saline implants are safe and approved for women over 18 years old by the Food and Drug Administration (FDA). These implants tend to offer a natural shape and feel.
PROS AND CONS OF IMPLANT BREAST RECONSTRUCTION
Advantages
- It can be performed by the majority of plastic surgeons, which means you do not have to search for a specialist. Implant reconstruction is usually cheaper.
- A relatively simpler procedure that can be completed in less than 3 hours.
- At most (unless there are complications), requires only an overnight stay at the hospital
Disadvantages
- Silicone and saline breast implants have a lifespan of about 10-15 years. Some patients may need additional surgery to remove or replace them.
- Implants may leak. When saline implants leak, the body reabsorbs the solution and the implant appears deflated. Silicone implants may leak without any warning or deflation.
- Some patients experience implant side effects such as capsular contracture (formation of excessive scar tissue around the implant)
2. Flap breast reconstruction
Also referred to as autologous reconstruction, this option entails rebuilding the breast using tissue donated from the patient’s lower belly or other areas. Patients can choose from various autologous tissue techniques, including DIEP flap, TRAM, PAP flap, Hybrid reconstruction (multiple donor sites), and TDAP flap.
DIEP and TRAM flap are the two of the most common autologous techniques:
- TRAM (transverse rectus abdominis muscle) flap – with this technique, plastic surgeons take a section (flap) of fat, skin, blood vessels, and muscle from the lower belly and use it to reconstruct the new breast shape. There are two variations of this method: free TRAM flaps and pedicled TRAM flap. In a free TRAM, the blood vessels that supply your new breast tissue are matched to blood vessels in the chest and microscopically attached. In a pedicled TRAM, the donated skin, fat, and muscle is slid under the skin up to the chest. The tissue’s blood supply is left intact (attached to the original supply in the abdomen).
- DIEP (deep inferior epigastric perforator) free flap – this is a variation of the TRAM technique that takes donor tissue from the abdominal region but does not use the abdominal muscle. For that reason, it is referred to as a muscle ‘sparing’ technique. The main advantage of this approach is that it minimizes complications such as post-operative pain, loss of muscle function, and risk of abdominal hernia. Because DIEP flap is a relatively new technique in the world of plastic surgery, not all plastic surgeons offer it.
PROS AND CONS OF AUTOLOGOUS BREAST RECONSTRUCTION
Advantages
- A new breast is rebuilt using your own natural body tissue
- Allergic problems are not a concern with autologous tissue breast reconstruction
- Just like a normal breast, your reconstructed breast will be able to grow in size or decrease with weight fluctuations
- Because donor tissue is extracted from the abdomen, your belly will be flatter and tighter. It is similar to as if you obtained a tummy tuck procedure.
Disadvantages
- Surgery is complex and requires a specially trained surgeon. For this reason, the procedure may also be relatively more expensive
- Procedure time can go up to 6 hours or longer
- You may be required to stay in the hospital for approximately 5 days
Note: direct flap breast reconstruction options are not available to all women. If you had previous abdominal surgery, smoke, are obese, or suffer from blood clots – this treatment might not be for you. You also need to have enough donor tissue to form the new breasts. If you are very slim, talk to your plastic surgeon to see whether you qualify for autologous reconstruction.
