Implant Or Flap Breast Reconstruction Surgery
Patients who would like breast reconstruction surgery have two options:
- Implant breast reconstructive surgery
- Flap breast reconstructive surgery
Our care team will answer any questions you have. Our goal is to provide you with the best option for your individual circumstances. Our high quality surgical care is done by board-certified breast surgeons.
Implant-Based Breast Reconstruction
Implant-based breast reconstruction uses either saline or silicone implants. This option is a good choice for women whose chest tissue has healed normally after a mastectomy and don’t need any radiation therapy.
Some patients can also use autologous tissue (the patient’s own tissue) as well as implants in the reconstructive process. Your surgeon will help you make the decision about which options are best for you.
Surgical Risks Specific to Implant-Based Reconstruction
Most women won’t have any complications with their reconstruction surgery; however, we want our patients to be informed about the possible risks of this procedure.
These risks include the following:
- Asymmetry—Reconstructed breasts often sit higher on the chest and are not as soft as normal breasts. There may also be differences in size between a reconstructed and a native (original) breast. Your surgeon can discuss surgical options with you to determine the best way to improve the overall symmetry of your breasts.
- Capsular contracture—Capsular contracture happens when your body reacts to a foreign material inside it. Your body will form a fibrous membrane, called a capsule, around the implant. Contracture is the most common side effect of using breast implants for reconstruction and is usually minimal if it occurs.
- Deflation—If you choose a saline implant for breast reconstruction, the valve on the implant can fail, which will allow the saline to leak out. While the saline, or salt water, will be reabsorbed by the body, you will have to have the implant replaced in another procedure.
- Reduced sensation—After your mastectomy, you may have noticed less sensation in the skin of your chest. The process of expanding and placing your implants may also cause new or additional changes in sensation. These changes may be temporary or permanent. If you lose sensation in your chest, your nerves can recover in one to two years. (85 percent of women who have breast reconstruction will regain their sensation.)
- Wrinkling—Some patients notice wrinkling of the implant underneath their skin. Some women can feel the edge of their implant. These problems are usually mild and don’t need to be treated. The wrinkles usually improve with time; rarely they may need to be corrected with another surgery.
Implants & Breast Cancer
There is no evidence of a link between getting breast implants and developing breast cancer. If cancer does develop in a reconstructed breast, it is more likely because the previous breast cancer has come back (reoccurred) instead of a new malignancy (new case of breast cancer) forming.
Silicone Rubber Inside the Body
Both saline and silicone implants use silicone. In the 1990s there were concerns from the legal industry, media, and FDA about using silicone gel in the body. There does not, however, appear to be a link between silicone implants and an increased risk of connective tissue disorders or breast cancer in women.
Tissue-Based/Flap Reconstruction
Tissue-based reconstruction is also called flap reconstruction and often uses tissue from your back or abdomen. Commonly used flaps are the:
- Latissimus flap (using the latissimus dorsi muscle), and
Abdominal flaps, such as the:
- DIEP flap (deep inferior epigastric perforator flap) or
- TRAM flap (transverse rectus abdominus myocutaneous flap).
DIEP & TRAM Flap Reconstruction (Abdominal Free-Flap)
During flap reconstruction, surgeons will take an abdominal flap from a section of your lower abdomen (belly). Abdominal flaps include your skin, fat, and sometimes muscle. Surgeons can use an abdominal flap to reconstruct breasts in women who have extra abdominal tissue.
During breast reconstruction, surgeons often use free flaps, a flap that is transferred along with its blood supply (a small artery and vein) from the abdomen to the chest where it is reattached to a small artery and vein.
Types of abdominal flaps include the:
- DIEP flap (deep inferior epigastric perforator flap), and
- TRAM flap (transverse rectus abdominus myocutaneous flap).
Surgical Risks Specific to Abdominal Free Flap Reconstruction
Most women don’t have complications (or problems) during their flap reconstruction surgeries. However, we want our patients to be informed about the possible risks of this procedure. These risks include the following:
- Delayed wound healing—Using tissue flaps requires us to make incisions on your back, abdomen, or other areas. This means there are other areas on your body that will need to heal. In some cases, patients take longer to heal because of inflammation, infection, wound tension, decreased blood flow, smoking, or external pressures. If the healing is delayed, we may need to surgically alter the scar.
- Hernia/Abdominal bulge—When a surgeon uses abdominal tissue, there is always a risk (chance) that tissue or muscle in the abdomen may become weak. This could cause a bulge in the abdomen or a defect or opening, called a hernia. A hernia must be repaired by surgery.
- Necrosis/Flap loss—When a tissue flap is used for reconstruction, the flap may sometimes not survive. The tissue may die, which is called necrosis or death of the cells. The chance of this happening is very small, only 1–2%; however, if the tissues die, a patient will need more surgery to remove the dead tissue and reposition the rest of the tissue.
- Reduced blood flow—Sometimes blood circulation to the flap is reduced because the blood vessels have been surgically connected. Your doctor can use an ultrasound to detect this. Patients may require additional surgery to reestablish blood flow.
- Seroma (fluid collection)—Sometimes a pocket of fluid, or seroma, forms under the skin—even though surgeons place drains under your skin to collect this fluid. To drain the seroma, we may have to remove the fluid by inserting a needle into the pocket to collect the fluid or apply a compression dressing (like an abdominal binder).
- Umbilical (belly button) complications—Sometimes your belly button may be deformed because of how tissue was rearranged during surgery to remove the abdominal flap. In rare cases, this may cause delayed healing or tissue death near your belly button that will need reconstructive surgery later.
Latissimus Flap Reconstruction
During a latissimus flap reconstruction, surgeons will take a flap of tissue from your back that’s made up of fat and muscle with or without skin. The flap will stay attached to its blood supply and is tunneled under the skin from your back to your chest. Surgeons will make an incision (or cut) along the bra line on your back.
This type of surgery is often used along with a tissue expander or an implant. In some cases, latissimus flap reconstruction can be used alone to create a small volume breast.
Surgical Risks Specific to Latissimus Flap Reconstruction
Most women will not have complications (problems) during latissimus flap reconstruction. However, we want our patients to be informed about the possible risks of this procedure. These risks include the following:
- Back asymmetry—The latissimus dorsi muscle is part of the curve of your back. Removing a flap from one side of the back may cause a small difference in appearance or symmetry of the back.
- Delayed wound healing—Surgeons take latissimus flaps from your back. You will have a surgical incision (cut) on your back that will need time to heal. In some cases patients do not heal quickly because of inflammation, infection, wound tension, lowered blood circulation, smoking, or outside pressure. If healing is delayed, we may have to surgically alter the scar.
- Muscle weakness—For most patients, losing some function of the latissimus dorsi back muscle will not affect their day-to-day life or activities. Most patients do notice some weakness on the side of their back where the flap was removed, but this usually heals with time. There are cases, however, where patients have a small level of disability while doing activities like rowing or swimming.
- Necrosis/Flap loss—When a tissue flap is used for reconstruction, the flap may not survive (necrosis or death of the cells). The chance is very small, one to two percent; however, when it happens more surgery is needed to remove the dead tissue and reposition the remaining tissue.
- Seroma (fluid collection)—Sometimes a pocket of fluid, or seroma, forms under the skin—even though surgeons place drains under your skin to collect this fluid. To drain the seroma, we may have to remove the fluid by inserting a needle into the pocket to collect the fluid or apply a compression dressing (like an abdominal binder).
Reconstructive Breast Surgery Doctors Near You
Breast Implants and the Risk of ALCL
Recently the Food and Drug Administration (FDA) has identified a possible association between textured breast implants and development of a rare form of cancer called anaplastic large cell lymphoma (ALCL).
The majority of the data suggests the cancer risk is associated with breast implants that have textured surfaces rather than those with smooth surfaces. The risk is low and thus far only a small percentage of patients with textured implants have been found to have ALCL in the United States. Nevertheless, out of an abundance of caution the FDA has recalled a specific brand of textured implants.
The Division of Plastic Surgery at U of U Health has stopped using all brands of textured implants in light of the recent concern of developing ALCL. Please note that the recall of these implants does not mean that the implants need to be removed. If you have concerns or questions regarding the recall please refer to the FDA website or speak with your doctor.
For More Information About the FDA's Ongoing Status on Breast Implants and ALCL
Hear From Our Patients
After being diagnosed with breast cancer, Terri Jones had a plan. “When it got to the idea of reconstructive surgery, all I knew is that I didn’t want anything foreign in my body,” Jones said. “I didn’t want implants and I thought that meant I wouldn’t have reconstruction at all.” After speaking to a friend who had breast cancer, Jones learned there are many more options when it comes to breast reconstruction than she realized. This meant she could make a choice right for her.
