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Autologous Against Implants

Breast reconstruction is a surgery performed to restore the shape of breasts after tissue is removed during mastectomy (surgery for treatment or prevention of breast cancer).

Breast reconstruction is performed by three methods:
  • Tissue flap reconstruction: using your own tissue (autologous reconstruction)
  • Using a tissue expander/implant
  • Combination of both

Tissue Expanders and Implants

This is commonly a 2-stage procedure. The first stage involves the placement of a tissue expander in the pocket formed by the part of the breast removed during mastectomy. The expander is a balloon made of silicone sheet, that is gradually filled with saline (salt water) over the course of a few weeks s to allow breast muscles and skin to stretch to the desired breast this stage, the expander is replaced by the permanent implant, which may be filled with either silicone gel or saline. The preliminary procedure (expander insertion) is done to create sufficient space to allow a permanent implant to sit comfortably in the right place and orientation, and avoid the risk of the implant coming out through the surgical incision.

This method is suggested for women with small to medium-sized breasts with mild ptosis (sag), undergoing bilateral mastectomy, and having healthy mastectomy flaps. The outcomes may not be so favorable for women who are obese, have large breasts, smokers or those who have had, or are likely to have radiotherapy to the breast. There is also the fact that one has to live with the presence of a foreign body in one’s body for all times to come. although modern implants are much safer than those available a decade back, there still are occasional reports of complications related to the nature of the implant being a foreign body.( these include: infection, implant displacement, implant leakage, allergic reactions to foreign materials).

Use of expander-implant: In selected cases, the problem of two stage surgery can be overcome by using a special type of implant called a double-lumen "Becker" implant. This implant is an expander and an implant rolled into one. It is a double chamber. The more superficial chamber is filled with silicone gel, and the deeper chamber works like an ordinary expander. It can be placed in a small pocket, and subsequently expanded by insertion of saline. After acquiring the desired size, the implant functions as a permanent implant.

Expander/implant and Acellular Dermal Matrix (ADM)

More recently, expander/implant reconstruction is augmented with a surgical mesh called acellular dermal matrix, which cradles the implant and gives the breasts a more natural shape, contour and droop. The matrix is a very thin white leather like sheet, made from human or pig skin that is extensively processed and preserved to ensure the safe insertion in human tissues.

The mesh can be used with or without the expander in a one-stage implant reconstruction, most often in conjunction with nipple-sparing mastectomy. This method may be more useful following preventive mastectomy in younger women.

Autologous Tissue Reconstruction using Own Tissue

Autologous reconstruction uses tissue taken from the patient’s stomach, back, buttocks or thigh (wherever there is excess tissue) to shape the new breast. This method of reconstruction allows the creation of breast sag. There are two types of autologous reconstructions: pedicled and free flaps. Pedicled flaps are supported by their local blood supply, but free flaps would be completely separated from their existing blood vessels and reattached through microvascular reconstruction at their new position in the breast. This is a more complex process which requires expertise of your surgeon in microsurgical procedures. For pedicled flap reconstruction, tissues can be taken only from adjacent areas of the body like back and abdomen, so there is a restriction of choices and techniques. For free (microvascular) flaps the choice is much wider, and greater refinement can be achieved in terms of size, shape and contour of the reconstructed breast. Also the scars can be placed more aesthetically in relatively hidden areas of the body.

Advantage of Autologous procedure vs. Implants

Like natural breasts, autologously reconstructed breasts consist of fat and skin (and sometimes muscle). They look and feel more natural than breasts with implants. They have a more lifelike drooping effect when compared to implants. They also enlarge or reduce along with your weight fluctuations just like a normal breast would. The risk of infection is much less when compared to an implant reconstruction since your own tissues are used for the reconstruction. As the tissue is harvested from your stomach, you also get a tummy tuck in the bargain. for patients who are not candidates for an abdominal flap (very young patients with flat stomachs, patients with multiple abdominal scars, patients whose stomach tissues have been earlier used etc.), tissues can be taken from other parts of the body, like thighs, back, buttocks to create a new breast.