Autologous vs. Implant

Benefits of Autologous Breast Reconstruction vs. Implants

 

If you had a mastectomy as part of your breast cancer treatment, you may be considering reconstruction to get back the look and feel of your natural breast. The two reconstruction options that patients normally choose between are autologous breast reconstruction and implant reconstruction.

Autologous breast reconstruction involves using your own tissue to recreate your breasts and can be done either when you have your mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Autologous breast reconstruction typically involves multiple stages; however, implant reconstruction often requires several stages as well.

With autologous reconstruction, a plastic surgeon uses the tissue from another place on your body (called a donor site) — typically from your abdomen, buttocks, or thighs – to recreate natural looking (and feeling) breasts. Using microsurgery, the surgeons attach vessels from the donor site to vessels in your chest to provide adequate blood flow to your new breasts.

Many patients who undergo autologous reconstruction, after having implants placed previously, state that their new breasts look and feel more like their old breasts compared to when they had implants.

Women who need radiation therapy before or after their mastectomy may also want to consider autologous breast reconstruction instead of implants because of the higher rate of failure associated with placing an implant under radiated skin and tissue. However, it is important to note that radiation must occur before undergoing autologous breast reconstruction.

Whether you decide to have autologous breast reconstruction or implant reconstruction depends on several factors, including your age, health status, location of the tumor, previous surgeries, and the availability of extra tissue in your body. There are pros and cons of each procedure, so it’s important to talk to your doctor about which one is best for you.

Implant reconstruction carries its own unique set of risks. Risks include inflammatory reaction, leaks, and mechanical implant failures.  There is also a chance that excessive scar tissue can form around the implants (capsular contracture) and cause pain and malposition necessitating removal or revision of the reconstructed breast. Due to these possibilities, implants may have to be surgically replaced or exchanged at a later time.

The Center for Natural Breast Reconstruction believes in good health for everyone. If you or someone you know is in need of breast reconstruction, contact them at NaturalBreastReconstruction.com or toll-free at 866- 374-2627.

Ask the Doctor – What Can Be Done To Fix a Previous Radiated Breast with Implant?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: What can be done for a 2004 radiated breast with implant. As common, it has encapsulated to a high degree and is painful, misshaped and raised, looking very unnatural. Thank you

Answer:  Without question, the course of action most likely to work is to remove the implant and proceed with reconstruction using your own tissue. If you still have breast tissue remaining, it can be removed by a breast surgeon at the same time that your healthy tissue is transferred.

The most common source for the new tissue (the “flap”) is the abdomen, which is usually harvested as a DIEP flap. If the abdomen is not available or not adequate, then the buttocks (“sGAP flap”) can often be used. Our success rates over the last 13 years are 99.07% using the DIEP flap, and 95.7% using the sGAP flap. The initial surgery requires on average 4 nights in the hospital, but subsequent stages are much easier.

If you can’t or don’t want to use your own tissue, there are a couple of other options which may offer some hope, although the chances of success are nowhere near as good as using your own tissue. One is a course of hyperbaric oxygen, which has been shown to bring new blood vessels to the radiated tissue.

Another potential option, which must be regarded as experimental at this point, would be to completely cover the implant with acellular dermal matrix, or “ADM” (Alloderm being the most commonly used variety). This material has some efficacy in preventing contracture, but the effect would be less pronounced in radiated tissue.

Hope this helps. I would be happy to discuss your situation further with you, if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor – Can I Have Large, Under Muscle Implants Replaced With Smaller Ones? Will This Make Them More Comfortable?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I’ve had my breast tissues removed and I now have implants. They are under my muscles, too large and very uncomfortable. Is there anything you can do to fix this and make a smaller implant? I am very unhappy with the way my breasts look, This is contributing to already very low self-esteem issues. Can you help me? What are my options?

Answer:  There is an excellent chance that we can help you. The country is currently undergoing a paradigm shift in implant-based breast reconstruction, with more and more surgeons placing the implants in front of the muscle, rather than behind. This allows for numerous potential advantages, and few disadvantages. We have been converting patients with unsatisfactory sub-muscular reconstructions to reconstructions in front of the muscle for a few years, with generally good-to-excellent results.

Another option is to remove your implants and re-build your breasts only with your own natural tissue, usually from tummy or buttocks. This is a larger operation than implant reconstruction but obviously results in an even more natural result.

I would be happy to discuss your situation further with you by phone, if you wish, or see you in my office when convenient.

Thanks for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor -After Two Different Types Of Reconstruction Over The Years, What Can I Do To Regain Some Symmetry?

Wild RoseThis week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I had my first mastectomy in 1991 with a tram flap reconstruction. My second mastectomy was in 2004 with an s-gap reconstruction. In the last few years, my breasts have become increasingly uneven and have shifted on my chest. Is there something I can do to my reconstructed breasts to regain some sort of symmetry?

Answer:  Without knowing any more specifics of your situation, I can state in general terms that asymmetry after reconstruction is very, very common and that there are a host of techniques which we routinely use to minimize asymmetry as much as possible. Some of these techniques are fat grafting, reduction, contour alteration, and position changing. We have currently performed almost 1700 perforator flap reconstructions, and we likely have significant experience dealing with situations very similar to yours. I would be happy to see you in consultation any time or chat on the phone if you wish.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor – Can I Have Large, Under Muscle Implants Replaced With Smaller Ones? Will This Make Them More Comfortable?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: I’ve had my breast tissues removed and I now have implants. They are under my muscles, too large and very uncomfortable. Is there anything you can do to fix this and make a smaller implant? I am very unhappy with the way my breasts look, This is contributing to already very low self-esteem issues. Can you help me? What are my options?

Answer:  There is an excellent chance that we can help you. The country is currently undergoing a paradigm shift in implant-based breast reconstruction, with more and more surgeons placing the implants in front of the muscle, rather than behind. This allows for numerous potential advantages, and few disadvantages. We have been converting patients with unsatisfactory sub-muscular reconstructions to reconstructions in front of the muscle for a few years, with generally good-to-excellent results.

Another option is to remove your implants and re-build your breasts only with your own natural tissue, usually from tummy or buttocks. This is a larger operation than implant reconstruction but obviously results in an even more natural result.

I would be happy to discuss your situation further with you by phone, if you wish, or see you in my office when convenient.

Thanks for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor – Can My Latissimus Flap Reconstruction Surgery Be Reversed?

This week, Dr. Kline, of The Center for Natural Breast Reconstruction, answers your question about breast reconstruction.

Question: I had that flap reconstruction 4 years after my mastectomy. That was 8 years ago. I’m in constant pain from the pulling in my chest. I hate that I can no longer paddle my canoe or swim.

I’m also having continued back problems that require the use of a chiropractor.

Can this procedure be reversed? I did not have any radiation or chemotherapy.

Answer: What type of flap did you have? It would be very unusual for a free tissue transfer (such as DIEP) to cause pulling, but not so unusual for pedicled flaps like a latissimus (or even a TRAM).

If you did have a latissimus, it could quite possibly be revised to improve your symptoms.

If you had a DIEP, it would require a little more investigation. Please let me know, and I’ll try to give you a more precise answer. I’d also be happy to chat with you by phone, if you wish.

Inquirer’s Response:

I believe it was a latissimus.

They used a portion of muscle from the side of my back, just a few inches lower than the armpit. The breast has also shifted slightly so that it isn’t centered in the chest anymore and is closer to the armpit.

In addition to the pulling pain in the chest, I’m having severe pain in the upper back, shoulders, and neck. I’ve also had recurring numbness and tingling in the hand and sharp pain shooting down my arm.

The chiropractor says that the realignment of the muscle will mean a forever battle of trying to keep the spine aligned and not pinching the nerve.  

Having the latissimus procedure is a huge regret for me. I wish I’d just had an implant.

The other breast just had a lumpectomy, rather than a full mastectomy. I have a small implant on that side that has never caused me any issues.

I want to know if the latissimus can be reversed and have an implant put in.

Answer from Dr. Kline:

I’m sorry you’re having so much trouble. That actually isn’t the norm for latissimus flaps, but it certainly can happen, as you know.

The latissimus can be transferred with or without dividing its motor nerve (thoracodorsal), and with or without dividing its attachment to the humerus (arm bone).

If the breast is shifting away from the center, that’s an indication that it may still be attached to the arm bone. If you have spasms, or intermittent pulling pain, it could be because the nerve isn’t divided, and the muscle is still functioning.

This doesn’t bother most people, but it definitely bothers some.

Sharp pain shooting down your arm (especially the inside of the upper arm) could indicate compression of the intercostobrachial cutaneous nerve, which lies in that area.

Offhand, I can’t think of an obvious anatomical explanation for your hand numbness and tingling, however.

Three muscles, the pectoralis major, the teres major, and the latissimus dorsi all attach to your upper arm bone at about the same place, and all pull the arm towards your body, but they each pull from a slightly different angle.

The latissimus is now rearranged to pull from the same angle as the pectoralis major. Usually, this does not cause a problem, but that’s not to say it never does.

It’s not really practical to actually “reverse” a latissimus flap, in the sense of putting it exactly back where it was. The flap can certainly be removed, however, and it is not at all unreasonable to think that that might help your symptoms.

In addition to perforator flap breast reconstruction, we also do implant reconstruction, but we shifted to placing the implant exclusively in front of the muscle about three years ago.

This can result in some visible rippling, but it has multiple benefits, including lack of animation deformity when the muscle is contracted, less chance of the implant coming out of position, less damage to the pectoralis muscle, and less discomfort.

Successful placement in front of the muscle is made possible by completely or nearly completely wrapping the implant in acellular dermal matrix (preserved skin, such as “Alloderm”), which heals to the tissue around it, and provides support.

While it may often be a very prudent decision to travel to see surgeons with extensive experience for complex procedures such as perforator flaps (DIEP, sGAP, PAP, etc.), simply removing the latissimus and placing an implant (or a tissue expander initially, which can be safer) requires no unusual skill, so I would recommend that you first consult your previous plastic surgeon, or another in your geographic area.

I would still be happy to speak with you about your situation, however, if you wish.

Have a great weekend, and thanks for your inquiry.

Have a question about breast reconstruction or post-surgery you’d like answered from our surgical team? Just ask!

 

 

Ask the Doctor – I Have Implants But They Feel Horrible And My Reconstruction Looks Terrible. Is There Any Hope After Reconstruction?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question:  I have implants. Do not like them they feel horrible and my reconstruction looks terrible. Is there any hope after reconstruction. I have appointment 2/23/2018.

Answer:  Fortunately, your previous unfortunate experiences with implants in all probability do not affect our ability to get you a satisfactory reconstruction using only your own tissue.

I look forward to meeting with you!

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor – Do You Have Experience Replacing Silicone Implants When a Patient is Having a Reaction to Them?

This week, Richard M. Kline, Jr., MD, of The Center for Natural Breast Reconstruction answers your question about breast reconstruction.

Question: Do you have experience replacing silicone implants when a patient is having a reaction to them?

Answer:  Thank you for your question.

We have extensive experience replacing implants when patients find them uncomfortable. Most of our experience is with patients who have had mastectomies and reconstruction, but the experience translates to patients who have had cosmetic breast augmentation, as well.

There are many reasons for patients to have problems with implants, some of which we understand, and some of which we probably don’t (yet).

Sometimes the problem can be as simple as the implants have ruptured, and replacing them may solve the problem. While this is very common with older implants (> 25 years old), rupture is much less common with modern gel implants, although it can happen.

Until very recently, breast implants for augmentation were placed exclusively under the pectoralis muscle. We abandoned this approach and started placing implants in front of the muscle (a more anatomically correct location) about three years ago. This is made possible by completely wrapping the implants in Alloderm, which provides strength and padding. Advantages of pre-pectoral (in front of the muscle) placement include less pain, no animation deformity, and a more natural appearance. The primary disadvantage is an increased likelihood of seeing “rippling” in some case. Fat grafting also sometimes necessary to maximize the final appearance. Encouraged by patient acceptance in these cases, we recently starting converting patients with previously placed submuscular implants to pre-pectoral implants. The results thus far, though early, have been very good, with most patients telling us “they feel more like breasts now.”

Of course, not all problems with implants are simply due to submuscular placement. Some people get painful hardening (capsular contracture) regardless of implant position, although the complete Alloderm wrap minimizes the chance of this occurring. Some people just don’t react well to having large foreign objects in them, without being able to narrow down the precise cause further, and these people may not tolerate implants at all. In these situations, if the implants were placed for reconstruction, we have the option of completely removing the implants and replacing them with your own natural tissue taken from your abdomen, buttocks, thighs, etc. This is obviously much more involved than just replacing implants, but the quality of the result is much more natural than an implant reconstruction, and problems after completion of reconstruction are extremely rare..

Any of these techniques could potentially be used for problems after cosmetic breast augmentation, but would involve significant out-of-pocket costs, as insurance will generally not usually cover procedures to correct problems from cosmetic surgery.

I hope this helps some. I would be happy to discuss your situation further with you by phone (1-866-374-2627), or see you in the office whenever convenient.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask The Doctor – Is it Prudent to Remove the Expanders?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had bilateral nipple sparing mastectomies on 2/9/16 and developed a large necrotic area on the lower pole of my left breast. Air expanders and Alloderm were placed during the surgery and I have also developed redness over the area where the Alloderm is on my right breast. I have been on Keflex 250 mg qid since surgery and Levaquin was added yesterday, 2/26. My surgeon plans to debride the necrosis and perform a skin flap on Friday 3/4. Of course there is no staging of the area under the necrosis at this point. (It turned dusky the day after surgery.)

But I am keen to avoid two surgeries. My questions are these: In your opinion, is it prudent to remove the expanders, allow time for healing and then consider latissimus flap on the left? Under that circumstance, what options are there for healing the wound after debridement? Would closing good skin to good skin be best (I understand distortion is a given) and then flap it later? I will have to be referred for flap surgery and am trying to do diligence on who best to request for this. I am grateful for any advice you might be willing to offer.

Answer:  I’m sorry to hear that you are having a difficult time. From what I can gather from your question it sounds like you have had a difficult time with both breasts. On your left side the healing would be less complicated if you had the expander removed. On the right side if you have an infection then it is possible that the implant may have to be removed.

If the implants are removed then when you have healed you may consider using your own skin and fatty tissue instead of trying another expander. We specialize in breast reconstruction using your own fatty tissue without using implants and without sacrificing your important muscles. That includes the latissimus muscle. I suggest you ask your surgeons if you can consider that route as an option.

I’m sorry I can’t be more specific without more information from you about your situation, previous surgeries and medical history. If you would like more information I could have my office contact you for specifics. Just let me know. Thank you for your question.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask the Doctor-Can You Fix a Bilateral Mastectomy Gone Wrong?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question:  Can you fix a bilateral mastectomy gone wrong? My breasts are now hideous to look at and I’m ashamed of my body now. They are lopsided and not even and I’m left with a 2 inch scar across my entire chest.

Answer: It is difficult to know what we might be able to do for you with the information you gave us, but usually something can be done to at least make things somewhat better.

Many of our patients had multiple prior surgeries elsewhere before we met them, and we were able to help many of them. We would be delighted to have one of our clinical staff members to call you to discuss your situation in more detail, if you wish.  Simply call 1-866-374-2627 or e-mail info@naturalbreastreconstruction.com and we can get that arranged for you.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!