Mastectomy Decisions: Weighing the Options Between Implants and Tissue Transfers
Navigating the Decisions Regarding Breast Reconstructive Surgery after Mastectomy
Undergoing a mastectomy due to breast cancer can be a distressing experience. If your healthcare providers recommend breast reconstruction surgery as part of the treatment and remission plan, it is essential to explore your options carefully before making a decision.
Cleveland Clinic, a non-profit academic medical center, provides valuable insights into the available reconstruction options. One such option involves breast implants or autologous tissue reconstruction.
Breast Implants
Breast implants can help boost self-confidence and improve body image but require careful consideration before choosing the appropriate type. Breast implants can be divided into two categories: silicone and saline.
Silicone Implants
These implants are filled with a cohesive gel that maintains its shape and provides a natural feel. Approved by the Food and Drug Administration (FDA) for women age 22 and older, silicone implants may require a two-part procedure with the temporary insertion of a tissue expander to create space for the implant.
Saline Implants
These implants contain saline solution and offer a uniform shape. Best suited for women with autoimmune conditions like lupus or Sjogren's syndrome, saline implants are FDA-approved for women aged 18 and older.
Pros and Cons of Breast Implants
While breast implants offer many benefits, they have certain drawbacks as well. Some advantages include:
- Most plastic surgeons can perform this procedure with a relatively simple process.
- The surgery may be performed as an outpatient procedure, allowing for quick recovery.
- The procedure typically takes one to two hours of operative time after a mastectomy.
On the other hand, implants have several disadvantages:
- Implants have a limited lifespan, necessitating additional surgeries for replacement or removal in the future.
- Some individuals might not tolerate implants.
- Implant leaks can occur, potentially leading to complications such as silicone migration or the need for implant removal for the cosmetic disadvantages.
Autologous Tissue Reconstruction
Alternatively, autologous tissue reconstruction can use abdominal fat, skin, and fatty tissue from your lower abdomen or other areas like your back or thighs to recreate a breast. There are two types:
- TRAM (transverse rectus abdominis muscle) flap: This procedure utilizes the blood supply from the rectus abdominis muscle along with the skin and fatty tissue. It can be performed in one of two ways: either by severing and reattaching blood vessels (free TRAM flap) or by leaving blood vessels attached and moving the tissue under the skin (pedicled TRAM flap) to the chest to rebuild the breast.
- DIEP (deep inferior epigastric perforator) free flap technique: A variation of the free TRAM flap that preserves the rectus abdominis muscle, this technique minimizes complications.
Pros and Cons of Tissue Transfer Breast Reconstruction
The pros of tissue transfer breast reconstruction include:
- This procedure utilizes natural tissues, eliminating allergic reactions.
- Tissue reconstruction usually requires no replacement or repair.
- Your breasts will grow or shrink with weight fluctuations, as would your natural breasts.
- Your belly will be flatter and tighter, giving the appearance of a tummy tuck.
However, the cons include:
- The surgery for autologous tissue reconstruction is complex, requiring a specially trained plastic surgeon.
- The procedure can last up to six hours.
- You might require a hospital stay of up to three days.
In some cases, tissue reconstruction is not advisable, such as if you have had previous abdominal surgeries, have obesity, smoke, or have a history of blood clots.
Best Time for Breast Reconstruction
Once upon a time, women would wait until after their cancer treatment and surgeries to undergo breast reconstruction. Today, that's not always the case. Immediate reconstruction is possible, with the first stage of reconstructive surgery taking place at the same time as your mastectomy.
In some cases, single-stage reconstruction may be possible, eliminating the need for additional surgeries. If radiation therapy is required and silicone tissue reconstruction is preferred, your surgical team might suggest a mixed approach, starting with tissue expanders during the initial mastectomy to prepare the breast skin for reconstruction after the treatment.
Ultimately, the choice of reconstructive surgery depends on your unique circumstances and personal preferences. It is best to discuss your goals for reconstructive surgery with your healthcare providers to make the most appropriate decision for you.
- Mastectomy due to breast cancer can affect not only physical health but also mental health, requiring careful evaluation of breast reconstruction options.
- Cleveland Clinic suggests consideration of breast implant surgery or autologous tissue reconstruction after mastectomy.
- Silicone implants, one type of breast implant, offer a natural feel and are FDA-approved for women aged 22 and older, though they may require tissue expansion before the implant is inserted.
- Saline implants, another type of breast implant, offer uniform shape and are FDA-approved for women aged 18 and older.
- Autologous tissue reconstruction uses fat, skin, and fatty tissue from other parts of the body to recreate a breast, with TRAM (transverse rectus abdominis muscle) flap and DIEP (deep inferior epigastric perforator) free flap techniques being options.
- While breast implants can boost self-confidence and provide quick recovery, they have limited lifespan and may lead to complications like implant leaks.
- Autologous tissue reconstruction uses natural tissues, requires a specially trained surgeon, and carries risks like a longer surgery and possible hospital stay, but it eliminates the risk of allergic reactions and offers the benefit of a flatter stomach.
- The best time for breast reconstruction may depend on individual circumstances, as immediate reconstruction after a mastectomy is now an option in some cases, but discussion with healthcare providers is essential to make the most appropriate decision regarding breast reconstruction for health and wellness, men's health, and women's health, including breast cancer.
