Mastectomy removes breast tissue to treat breast cancer or to reduce a high risk for developing it. Breast reconstruction replaces that natural tissue with a breast implant, your own excess tissue or a combination of the two.
Although reconstruction can be accomplished with breast implants, autologous breast reconstruction—replacing breast tissue with fat from your abdomen, buttocks, thighs, hips or back—results in new breasts that feel and move more like natural breasts. That’s because unlike the saline or silicone gel that fills breast implants, autologous reconstruction replaces fat with fat. After autologous breast reconstruction, your new breasts consist primarily of fat, just as your natural breasts did before mastectomy.
Compared to reconstruction with breast implants, autologous reconstruction offers advantages, but it has disadvantages as well.
Advantages of autologous flaps
Recreate breasts that feel, look and move like a natural breast
Form full-sized breasts during the initial operation. (Direct-to-implant reconstruction also forms full-sized breasts during the initial operation. Breast reconstruction with implants that require tissue expansion forms an initial breast mound that is gradually inflated over time. )
Although recovery is longer, the overall reconstruction timeline is shorter than reconstruction involving tissue expansion
Don’t require tissue expansion.
Improve the likelihood of regaining sensation in the new breast
Avoid capsular contracture, rippling and other inherent complications of breast implants that may require additional surgery and replacement
Rarely fail.
Last a lifetime without needing to be replaced
Less likely to develop problems if your chest has been or will be treated with radiation
May provide more volume than the largest implant
Can be sculpted to desired shape (especially after unilateral mastectomy when you want your reconstructed breast to closely match your opposite natural breast).
Disadvantages of autologous flaps
Scar the donor site as well as the mastectomy site
While advanced autologous procedures use only fat and skin to recreate the breast, more traditional autologous procedures sacrifice the muscle as well, extending recovery time and possibly affecting strength and functionality at the donor site
Recovery involves both the mastectomy and donor sites and is typically longer than recovery from reconstruction with implants
The area around the donor site scar may remain permanently numb
Not all plastic surgeons have the training and expertise to perform autologous procedures
It's always a good idea to research and understand all of your postmastectomy options before making a decision that best matches your priorities.