Unilateral Mastectomy - Reconstruction Options?

Question

I had a unilateral mastectomy (left side), and an expander placed 3 weeks ago. My plan was to reconstruct with the DIEP flap procedure. I am concerned about using one implant re: aging/ symmetry/ etc. (I will have a lift/reduction on the right side). Now i'm inclined to do the shorter, less invasive implant surgery for reconstruction. How common is it to reconstruct with an implant after a unilateral mastectomy? what are the risks or concerns of this approach vs. DIEP reconstruction?

Tracy Kayan, MD · Answer

A reconstruction using your own tissue has a better chance of matching your non-reconstructed breast than if were to use an implant. The issue with an implant, regardless of the type, is that there may always be a more round appearance and the appearance of a fuller top portion of the breast (upper pole). Even if the DIEP surgery is a lot longer, it gives you the best chance of having a lasting symmetry. Over time, even if you get a lift/reduction on your right side, this tissue will re-settle with gravity, and the left side (if you choose to have an implant), will descend less.

Paul Gill, MD · Answer

Thank you for your question.   Based on our ASPS patient satisfaction surveys, patients have a better body image and more natural result with the DIEP flap.   However, this is longer surgery and hospital stay and a similar recovery to implants.   Implants are a shorter surgery and hospital stay, but not as natural a longterm result.   There is not a key for every lock and some patients do not respond well to implant alone.  We are now exploring fat grafting more aggressively in implant reconstruction, which can help to camouflage the implant look.   Please meet with an experienced board certified plastic surgeon to learn more.    All the best.Dr. Gill

Mark Deutsch, MD, FACS · Answer

There are pros and cons of using implants vs. flaps and a lot depends on patient selection. Are you going to need postop radiation? Do you have enough abdominal tissue to use for a DIEP flap? I am assuming your breast is on the larger/more ptotic side if you state you will need a lift/reduction on the right side. It is best that you discuss your concerns with a plastic surgeon who does all types of reconstruction to determine which plan is best for you,

Mark A. Brzezienski, MS, MD, FACS · Answer

I reconstruct unilateral mastectomies with implants with great frequency.  The "match" presents some challenge, but achieving a perfect match with autologous tissue is not a certainty, either.  Implant technology has come a long way, with several different shape options for each implant size.  Attention to the shape of the remaining breast is very important. Fat grafting is my "go to" technique for improving symmetry and correcting contour abnormalities.Projecting persistent symmetry, over time, is a tall order.  Normal physiologic changes in our bodies, weight gain / loss, and gravity all take their tolls on even the most perfect native breasts.That being said, having been in practice for over 20 years, I have had patients on whom I performed TRAM reconstructions in the 90's return for reconstruction of the remaining breast after a second mastectomy.  I find that implant based reconstructions can be the equal of autologous reconstructions.

C. Bob Basu, MD, MPH, FACS · Answer

You may want to consider autologous reconstruction.  Many women prefer 
to utilize their own excess skin and 
fat on their tummy (essentially using excess tissue that would be thrown
 away in a cosmetic tummy tuck) with a procedure called a DIEP free 
flap (tummy tuck breast reconstruction).   In this procedure, we move 
healthy tissue with its own bloody 
supply and healing potential to restore the chest wall and breast after 
cancer treatment.  Autologous (using your own tissue ) reconstruction is
 especially powerful after radiation therapy. As you are learning, there
 are limitations with implant based reconstruction.  Although implants are very safe, they are foreign bodies.  Whereas autologous 
reconstruction helps to restore a soft supple breast using your own 
tissue.   
 Please see a board certified plastic surgeon who is well versed with 
autologous reconstruction to learn more about your options.Dr. BasuHouston, TX

Mark Gaon, MD - Account Suspended · Answer

Unilateral reconstruction with implants is done very commonly after mastectomy. While it is a little more challenging to achieve perfect symmetry to the other breast, improvements in technology and technique have given us more success. With the use of new cohesive gel shaped implants with higher profiles, human tissue allografts, and fat grafting, implant based reconstruction has become a very good option. Also if you are ultimately unhappy with the cosmetic result of your implant based reconstruction, you haven't burned any bridges and can choose to convert to a DIEP flap at a later time. Your most important decision will be to choose a qualified board certified plastic surgeon with experience in both implant based and autologous tissue reconstructive techniques who can guide you through your decision making process. Best of luck!

Unilateral Mastectomy - Reconstruction Options?

Answers (6)

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