Welcome to our breast reconstruction Q&A blog series with Scott Sullivan, M.D., F.A.C.S. of the Center for Restorative Breast Surgery in New Orleans, LA. In this installment, Dr. Sullivan compares implant reconstruction with reconstruction using your own tissues (flap reconstruction).
Read Dr. Sullivan’s Q&A on Flap Reconstruction.
Read Dr. Sullivan’s Q&A on Implant Reconstruction.
How do you know whether implant reconstruction is better for you than reconstruction that uses your own tissue?
Obviously, this is a personal choice, but there are a number of questions you can ask to start figuring this out.
Some have to do with lifestyle. Are you very active? What is your sport? Do you play golf all the time? Are you training for a triathlon? Or do you have a more sedentary lifestyle? If you’re very active, sometimes implants may not be the best choice for you. They can cause tightness, and you might not want that if you play tennis or golf or love rock climbing, because you use the chest muscle for all of those things.
Another question: How do you feel about implants? Some people are fine with them and have no concerns. Others think, “I don’t want anything foreign in my body. What if I have some kind of autoimmune or allergic reaction?” Maybe they have friends who had bad experiences. Some people just have an aversion to implants. Others don’t.
Are you OK with the eventual need to have implants replaced? At some point they will need to be changed out: it could be 3 years from now or 20 years. It’s an easy, 10-minute operation, but it’s a risk. Some people are OK with that, others are not.
Did you have or will you have radiation? Then you’re probably better off using your own tissue than an implant.
How do you feel about having another scar on your body? I can’t do flap reconstruction without putting a scar on another area of the body. Some patients come in and admit they’re worried about implants, but they also can’t handle having a scar on their abdomen or buttocks or thigh. So maybe implants are the best choice for them. When I am working with a younger woman who is out there dating and not yet married, I know that a major scar elsewhere on the body might not be right for her. Maybe she doesn’t want to deal with this as she is dating young guys who really don’t understand her diagnosis with cancer or with a BRCA mutation. Implant reconstruction is easier to do and only creates a scar on the breasts. Then later on if she is in an established relationship or married, she has that foundation of support and can revisit her decision.
Finally, what shape is your body in? Some women come in and are in great shape, very fit, and maybe another scar isn’t something they want — and they might not have extra tissue to create a flap anyway. Implant reconstruction may be a better choice. Others are less fit and actually can get significant improvement in the body by removing fat from another area to reconstruct the breast. They will have a better body and this, along with the reconstruction, can boost confidence.
These are all questions we discuss as we guide women who are making this decision.
