Implants or Tissue Transfer: What’s Right for You After a Mastectomy?

Work with your doctors to find the best approach

Implants or Tissue Transfer: What's Right for You After a Mastectomy?

If your breast cancer treatment includes a mastectomy, take time to explore your options before deciding on breast reconstructive surgery. But don’t put off your research. Reconstruction sometimes is done during the mastectomy.

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Reconstructive surgery can boost your self-confidence and improve your body image. But you’ll want to learn more before deciding which choice is right for you.

There are two main reconstructive options, says plastic surgeon Risal Djohan, MD. You can get artificial breast implants or opt to have the surgeon recreate your breasts with your own fat tissue.

Fortunately, thanks to government regulations and support for breast cancer services, most insurance providers pay for reconstructive surgery as part of cancer treatment, he says.

Implant options

In many cases, breast implants require a two-part procedure. The surgeon may first need to insert a temporary tissue expander to create space underneath the layer of skin and fat for the implant, Dr. Djohan says.

A few months later, your physician removes the expander and inserts an implant in the newly created pocket.

For some patients, however, doctors can immediately place the implant, Dr. Djohan says.

“Depending on evaluation of the patient meeting certain criteria, we certainly can skip a step of operation and get everything done at the same time,” Dr. Djohan says.

You have two options for breast implants:

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  • Silicone implants: Filled with silicone gel, these implants feel to the touch more like natural breast tissue, and maintain their shape well, he says. They are approved for use by the Food and Drug Administration (FDA) for women older than age 22.
  • Saline: These implants contain saline solution and offer a uniform shape and feel. They’re Food and Drug Administration-approved for women older than age 18. They’re best-suited for women with autoimmune conditions, such as lupus or Sjogren’s syndrome, who might have an allergic reaction to a silicone leak, Dr. Djohan says.

There are pros and cons to breast implants, Dr. Djohan says. In making your decision, it’s important to think these points over carefully and talk with your surgeon if you have questions.

Pros:

  • Most plastic surgeons can perform breast implant surgery.
  • It’s a relatively simple, 90-minute procedure.
  • It requires only an overnight stay in the hospital.

Cons:

  • Silicone and saline breast implants have a life span of about 10 years. You may need additional surgery at some point.
  • Some people have allergic reactions to implants.
  • These implants sometimes leak. Leaked silicone can escape the implant shell and float free in the reconstructed breast. The body will reabsorb leaked saline, but the implant will deflate.
  • Also in rare case, capsular contracture, where internal scar tissue forms tightly around the implant may occur.

Autologous tissue reconstruction

Autologous reconstruction involves using abdominal fat, skin and fatty tissue from your lower abdomen or other areas, such as the back, to recreate a breast.

There are two kinds of autologous tissue reconstruction:

  • TRAM (transverse rectus abdominis muscle) flap: Uses the blood supply of the rectus abdominis muscle along with the skin and fatty tissue. There are two kinds of TRAM flap procedures: one in which blood vessels are severed and reattached (a free TRAM flap); and one in which the blood vessels are left attached (a pedicled TRAM flap) and the tissue is moved under your skin up to your chest to rebuild your breast.
  • DIEP (deep inferior epigastric perforator) free flap technique: A variation of the TRAM flap that does not use the rectus abdominis muscle. The main advantage of the DIEP free flap technique is that complications are minimized.

Dr. Djohan describes the pros and cons of autologous tissue reconstruction this way:

Pros:

  • This procedure relies on your natural tissues.
  • Allergic reactions are not a problem.
  • There’s never a need for replacement and rarely a need for repairs.
  • Your breasts will grow or decrease in size with weight fluctuations, as would a normal breast.
  • Your belly will be flatter and tighter, as if you’ve had a tummy tuck.

Cons:

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  • The surgery for autologous tissue reconstruction is complex. It requires a specially-trained plastic surgeon.
  • The procedure can last up to six hours.
  • You may stay in the hospital up to three days.

Autologous tissue reconstruction is not recommended in some circumstances, such as if you have had previous abdominal surgeries, are obese, smoke, or have a history of blood clots.

Timing

In the past, women who had mastectomies waited until after their cancer treatment and surgeries before tackling breast reconstruction. Today, that’s not always the case.

Now there are options for immediate reconstruction. In this case, the first stage of reconstructive surgery occurs at the same time as the mastectomy. This requires close coordination between the cancer surgery and plastic surgery teams.

In some cases, single-stage reconstruction is possible. The surgeon inserts implants or fat tissue without additional reconstructive surgeries. Some women find this option makes recovery easier, socially and emotionally, Dr. Djohan says.

However, if you need radiation and want to use your own tissue for reconstruction, your surgical team might suggest a mixed approach. In this case, your surgeon would insert tissue expanders during your mastectomy. This prepares the breast skin for further reconstruction after your treatment is complete.

Ultimately, it’s best to discuss your goals for reconstructive surgery with your healthcare providers, Dr. Djohan says.

“If you have a mastectomy, you may choose a reconstructive surgery that makes you feel most comfortable,” he says. “A conversation with your doctor and plastic surgeon can help guide your choices so you make the most appropriate choice for you.”

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