appearance of your breast, which again would require more surgery to correct. And because implants aren’t part of your body, they have a greater chance of causing an infection in the surrounding tissue.
How do surgeons reconstruct a breast from your own tissue?
Reconstructing a breast from your own body tissue is a much more extensive procedure called flap reconstruction. It involves taking a section of skin, fat, and muscle from your abdomen (the transverse rectus abdominous skin-muscle or TRAM), upper back, or, less commonly, from your thighs or buttocks and using that to fill your breast pocket. Unless you’re very thin, there’s likely to be enough extra fat and skin in your lower belly to make a nicely shaped small to medium-sized breast.
Leaving the flap of tissue partly attached to its blood supply, the surgeon slides it up under the skin to fill the empty breast. The additional skin on the flap can be used to replace any that was lost during the mastectomy, which makes an expander unnecessary. The abdomen is closed, with the scar extending from hip to hip, much like that from a “tummy tuck,” and you’ll get the same result — a flatter stomach. Sometimes the surgeon will replace the muscle with surgical mesh to prevent a hernia. There’s a permanent side effect from this surgery, however: you lose so much abdominal muscle that you may no longer be able to do a sit-up or move from a lying to a sitting position without difficulty.
If the tissue is being taken from your back, there may not be enough to fill the breast, and the surgeon may need to use an implant as well. Using tissue from the buttocks is a highly complex procedure in which the tissue (called a free flap) is completely detached from its original blood supply and reattached to blood vessels in your underarm. This operation, done only at certain hospitals around the country, requires the skills of a plastic surgeon trained in microsurgery.
Flap reconstruction usually takes six to seven hours and requires you to stay in the hospital for three to six days. Recovery times differ depending on the procedure and the individual patient. In general, it takes longer to recover from flap surgery than from implant surgery, and several months may pass before you’re back to normal.
Some women choose to stop after this operation and live with a breast mound that fills clothes and bathing suits; others opt for the additional surgery that creates a nipple and areola.
If you choose to get additional surgery, you’ll return after the previous incisions have healed. Your doctor will shape the nipple from the skin of the reconstructed breast or use part of the skin from your other nipple. This reconstructed nipple will always appear to be erect. An areola may be made with a tattoo or with a skin graft of dark skin, usually taken from the crease where the inner thigh meets the groin. During this operation, the surgeon may do a lift, a reduction, or an enlargement of the other breast to make it match the newly reconstructed one.
What are the risks associated with flap reconstruction?
This is a major surgical procedure and will likely involve extended recovery and healing. You may also experience changes in breast sensation and some loss of sensation at the tissue donor site. Poor wound healing and fluid collection and infection are additional risks.
Your reconstructed breast will feel somewhat firm at first but will soften as it adjusts to the new blood supply. In a small percentage of cases, part or all of the transplanted tissue fails to get enough blood and dies. If that happens, you may need further surgery to remove the dead tissue and reshape the breast. This is more likely to be a problem after a free-flap procedure. With the TRAM flap, the muscles in your abdomen are likely to be permanently weakened.
How do I choose which is better for me?
Having your breasts reconstructed with implants requires a shorter operation, which means less time under anesthesia and usually less blood loss, plus a shorter recovery time. And you’ll generally have less scarring. A flap procedure involves surgery on the donor site as well as your breasts, which results in scarring and the potential for complications in both places.
On the other hand, implants don’t have the consistency or feel of normal tissue; they don’t move or hang like a normal breast and will always feel firmer. Sometimes you may be able to feel the edges of the implant beneath the skin of your breast. However, even a breast reconstructed from your own flesh will not feel like a normal breast. Women should be warned that reconstructed breasts “will not have normal sensation, and at times can cause chronic pain from cut-nerve endings. A reconstructed breast will not feel, move, nor age like a regular breast,” wrote President Debra Johnson of the American Society of Plastic Surgeons in the Times, adding that she hoped future research would one day alleviate these problems.
Numbness after reconstructive surgery may not go away, according to some breast cancer survivors. In a letter to the New York Times, one woman reported that she could no longer feel her children when they hugged her.
The decisions surrounding breast reconstruction are complicated and personal. Your surgeon and plastic surgeon should be able to help you sort through the issues and come up with the solution that will work best for you.