The Complete Guide to Understanding Breast Reconstruction: Reconstruction Surgery Techniques | Part 2/5
Learning About Reconstruction Surgery Techniques
Breast Implants: Saline or Silicone
Breast reconstruction using implants requires your plastic surgeon to insert bags filled with liquid or gel into the breast area. The implants are the same as ones used in regular breast augmentation surgeries. While implants are usually restricted to women 18 or even older for augmentations, women of any age are permitted to receive implants in the case of breast reconstruction.
Remember that a doctor may advise against implant reconstruction until after your post-mastectomy treatments are completed.
Saline implants have been used since the 1960s as medical prostheses. They have long been considered a safe, effective way to do breast reconstruction after mastectomy. Saline implants are usually inserted and then filled using a small valve once they are in place. Liquid can be added or removed as your surgeon makes minor adjustments during surgery.
Silicone implants are also used for reconstruction. Silicone is thicker and, therefore, has the reputation of feeling more like breast tissue than saline; however, improvements have been made in saline implants over the years. In fact, studies show that women choose saline and silicone implants at about the same rate each year. Silicone implants are already filled at the time of reconstruction, and the surgeon simply places the implant without further adjustments.
An implant reconstruction can be done with the mastectomy (immediate) or months after (delayed). If you are planning to do a delayed reconstruction, you will probably have a skin expander in place in your chest area until your implant is inserted. When the surgeon is ready to finish your reconstruction, he or she will remove the expander. Some skin expanders do double-duty, also serving as the permanent implant as well.
Implant Reconstruction- During or After Mastectomy
During reconstruction, the plastic surgeon will insert an implant under the muscle tissue in your chest. It may also be necessary for your plastic surgeon to form a graft or reposition muscles to support the implant.
Recovery from an implant reconstruction can be anywhere from 3-4 weeks up to a few months depending on factors such as the patient’s overall health and healing rate.
Tissue Flap Surgery for Breast Reconstruction
Flap reconstruction, also called autologous reconstruction, uses a flap of skin from another part of your body to form the new breast tissue. Depending on how much extra skin and fat you have, a flap reconstruction may not be an option for you.
Autologous reconstruction can be done at the time of your mastectomy or any time after it. Because the flap serves as the new skin, you will probably not need to have a skin extender inserted with this type of reconstruction.
During an autologous reconstruction, your plastic surgeon would remove a piece of skin and muscle from one area, cover the breast area with it, form it into the desired shape and then stitch it into place. Depending on which donor site you choose, your surgeon may have to perform one or two microvascular surgeries to connect blood vessels to their new location.
Where is the skin removed from?
The most common areas to remove skin from are the belly, back, buttocks or the inner thigh. These areas typically have skin that is most similar to breast tissue, and they have the largest amounts of fat in the body. This type of procedure is sometimes preferred because of its ability to move fat around your body. Many women are pleased to find out that they can use unwanted tummy tissue, for example, to reconstruct a breast after mastectomy.
Especially when the flap is pulled from your back, it may be necessary for your surgeon to do a hybrid procedure. Since the muscle on the back of your shoulder is thin, the surgeon would also place an implant underneath the flap for the most natural look and feel.
Recovery time for flap tissue reconstruction
Flap-reconstructions usually have a longer recovery period because the tissues have been removed and reconnected. You should be sure to choose a surgeon who has plenty of experience in microvascular procedures. Also, with this type of reconstruction, you will have at least two recovery sites, maybe more depending on how much tissue you that could be used from a certain area.
Breast Reconstruction Flap vs Implant- Weighing Pros and Cons
Each reconstruction option has its positive and negative points, depending on whom you ask. Ultimately, something is only a “pro” or a “con” if you think it is. Therefore, you should weigh each option carefully before making your decision about breast reconstruction.
Both saline and silicone implants are FDA-approved prostheses. The pros and cons represented here do not have to do with safety, as both have been independently tested to ensure their safety. The information below has strictly to do with personal preferences.
Saline implants have been around for a long time.
- Advances in technology have improved the look and feel of saline implants.
- Saline implants usually result in a smaller incision because the implant is filled with solution after it is inserted.
- In the event of a rupture, the saline solution is naturally absorbed by your body, causing no long-term effects.
- Many women claim that saline breast implants do not feel as natural as silicone implants or flap reconstructions.
- Breast implants usually need to be replaced every 10-20 years.
- Although ruptures are not commonplace, saline implants do tend to rupture more that silicone ones.
Silicone implants are similar to saline implants, but they do have some noted differences.
- The most well-known benefit of silicone implants is their realistic look and feel.
- Silicone implants do not tend to rupture as often as saline implants.
- The “gummy” texture of silicone implants prevents wrinkling under the skin (often felt with saline implants).
- Silicone implants cannot be adjusted once they are inserted the way saline ones can.
- If a silicone implant ruptures, the leaked gel can cause breast pain or discomfort or a change in the shape of the breast because the body will not absorb it.
- A larger incision is needed to insert the whole implant at once.
Flap reconstruction is different from implant reconstruction in several ways. You may decide, after weighing all the pros and cons, that flap reconstruction is a better choice for you than implant reconstruction.
- Flap reconstruction usually does not have to be redone as implants do since it does not use any foreign material.
- Your breast reconstruction will feel natural because it is made of natural tissues from your body.
- Flap reconstruction is not usually affected by further radiation treatments, so it can be done any time.
- Recovery from flap reconstruction can be timely because of the reconnection of tissue.
- In most flap reconstructions a muscle is completely removed from one area, so you can experience permanent muscle weakness at the donor site.
- You may have soreness, pain, and risk of infection at both the donor site and in your breast area during recovery.