Natural Tissue vs. Implant
One of your biggest decisions will be whether to have reconstruction with breast implants – which can be placed easily but have a limited lifetime – or to have reconstruction using your own tissue, which is more involved initially but can offer a permanent solution as well as several other benefits. There are advantages and disadvantages to consider for each.
Implant reconstruction only takes about one hour when done on both sides (bilateral). It requires a short hospitalization of one to two days when performed at the time of mastectomy and can be done on an outpatient basis if reconstruction is delayed.
However, if you opt for an implant you will be adding a foreign object to your body, and that will increase your risk of infection soon after surgery. In addition, the implant might move, so it’s no longer positioned correctly, or fail in other ways.
One of the most common problems is capsular contracture in which the scar tissue (capsule) that forms around the implant starts to tighten, making the breast feel hard and painful and look distorted.
Also note that when implants are used for reconstruction a woman has little to no breast tissue left to cover them. As a result, breasts reconstructed with implants will not feel or look as natural as breasts that have been enlarged with implants for cosmetic reasons. Yet women who have implants can expect to gain more breast sensation than those who have natural tissue reconstruction.
An implant will rupture and will require more surgery at some point. The average lifespan of an implant is 13.5 years. Replacement of an implant usually only takes about 30 minutes and can be done through an outpatient procedure.
Natural tissue reconstruction
With this approach, the surgeon transplants tissue from one part of your body and uses it create a soft, full breast that should live with you for the rest of your life. At MUSC, we often transfer a flap of skin and fat from the abdomen, typically using the DIEP procedure, which has a success rate around 97-98 percent. But a flap of tissue may be taken from the buttocks, thigh or back, depending on what will work best for you.
Because the flap is made of your own tissue, it will continue to act as a part of you, for example, growing or decreasing in size as you gain or lose weight. Your breasts will look and hang in a more genuine way and will feel more natural to the touch than breasts reconstructed with implants.
It’s important to know that natural tissue reconstruction may involve more time and effort on the front end than implant reconstruction. Yet the plastic surgeons at MUSC are able to perform the initial procedure in half the time of some centers with less experience. It usually takes us three to four hours to reconstruct one breast with natural tissue and microsurgery – six to eight hours to reconstruct two breasts. Afterward, you will stay in the hospital three to four days.
Patients often have a revisional surgery to make the breasts look as similar as possible and to resolve any issues from your abdominal scar. This second surgery is typically a one-hour outpatient procedure. Nipple reconstruction may be done at this time or in a later outpatient procedure.