Are Implants Better Than Flaps for Breast Reconstruction?
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A woman who is faced with losing her breasts due to breast cancer is likely forced to endure both psychological and physical consequences. Breast reconstruction surgery works to address both aspects by rebuilding both the look and feel of the breasts.
Multiple treatment options exist for women who are considering undergoing breast reconstruction surgery, and each option has important factors that should be considered and discussed prior to definitive surgical decision-making.
As a patient, is it important that you have the adequate knowledge and education to help determine whether you are likely to derive maximum benefit most from breast implant-based reconstruction, reconstruction using tissue flaps (usually taken from the abdomen or back), or some combination of the two approaches.
While women can find success with both methods, many choose to undergo breast reconstruction with implants. This is NOT because implant reconstruction is BETTER than flap-based reconstruction. Quite to the contrary: flap reconstruction—whereby tissue is moved from one part of your body to the missing breast in order to create a breast shape made from your own body’s tissue—can provide a very realistic breast shape and natural feel that can be an excellent choice for many women.
What Are the Advantages of Implant-Based Reconstruction?
1. It Can Often Be Performed at the Same Time as Your Mastectomy
In the large majority of mastectomy circumstances, both implant-based and non-implant (autologous) reconstruction can be performed at the same time as the mastectomy (e.g., immediate reconstruction).
Implant reconstruction is most commonly performed in stages, with a partially-filled tissue expander placed inside the breast pocket at the time of the mastectomy. This step is followed by the expansion of the tissue and then the eventual placement of a permanent implant. The second step is completed as an outpatient second procedure performed several months later.
Select women who are deemed appropriate candidates can skip the expander step and have permanent implants placed at the time of their mastectomy (e.g., direct-to-implant (DTI) reconstruction).
2. Less Invasive
One of the most desirable aspects of implant-based breast reconstruction is the ability to avoid the need for other incisions to be placed on additional body parts (besides the breast). Because autologous/flap reconstruction involves moving tissue from one part of your body to another, two areas are required to heal: both the breast and the donor-site (the location where the transferred tissue came from).
For many women, the ability to not address or worry about donor-site considerations is very appealing. Additionally, because implant techniques don’t require other surgery on other body regions, the total surgery time in the operating room is typically lessened.
Not all women are healthy enough to undergo the lengthier flap based procedures, and overall inpatient hospital time is likely lessened with implant-based reconstruction compared with flap-based options.
Recovery time for breast reconstruction is an important and relevant topic and needs to be contrasted/compared with alternative flap options as one of the many aspects to be considered.
3. Scarring Is Limited to the Breasts
Since only the breasts are operated on during implant-based reconstruction, scars remain limited to the incisions used to perform the mastectomy along the breast mounds. Some women are candidates for nipple-preserving techniques. In many cases, mastectomy scar locations can be positioned in natural creases/folds or in such a manner that attempts to conceal scar appearance and location.
Flap techniques (TRAM, DIEP, latissimus dorsi, etc.) are thoughtful regarding scar placement and aesthetics but cannot be performed in a scarless manner. Therefore, these donor-site scars need consideration.
4. Appropriate Option for Most Women
Another benefit of implant-based reconstruction is that it is a reasonable choice for most body types. Thin women may not be able to undergo abdominal flap reconstruction because they do not have enough excess tissue along their lower torso to create an adequate breast shape.
Smokers, diabetics, women with a history of prior breast radiation, and large-breasted women who need significant skin tailoring at the time of their mastectomy may be sub-optimal candidates for reconstructive techniques that use only implants; however, breast implants can often be utilized synergistically in combination with flap reconstruction to address some of the aesthetic and safety concerns that may exist in women who would otherwise benefit from implant-based techniques.
5. Customizable Options
With implant-based reconstruction, implant dimensions are ideally customized to address a woman’s individualized anatomy. The permanent implant’s diameter and projection should be based on patient-specific measurements and should be assessed and discussed prior to the mastectomy.
With the use of an expander prior to the permanent implant, the patient has the ability to be a knowledgeable participate in conversations with the plastic surgeon about final implant fill-volume/size prior to selection of the permanent implant, allowing for final breast appearance to result in a fuller or smaller shape than their pre-mastectomy volume based on individual patient desires.
Implants come with various options regarding cohesiveness (softness) and type (saline vs. silicone) that permit further customization of the final result.
While no type of breast reconstruction is suitable for all women, breast implants are a safe and common tool frequently used in reconstructive techniques. It is important that every patient facing a conversation about mastectomies be permitted to have a thorough and detailed consultation with their plastic surgeon about both implant-based and non-implant-based modalities of reconstruction.
Both implant and non-implant methods are associated with high patient satisfaction, and breast reconstruction is a nuanced, individualized procedure that needs to account for many considerations simultaneously.
Our practice treasures the relationships we have with our breast reconstruction patients, and we place a high value in the trust our patients have in us to help assist them in navigating these important conversations.