Breast Reconstruction

Silicone breast implants are one of the most studied medical devices in history. According to manufacturer research, the rupture rate for the most commonly used silicone implants is about 10% after 17 years. In addition, there are other issues that could arise at the surgical site, even if the implant remains intact. For example, a woman may develop capsular contracture, which happens when the scar capsule around the implant hardens; or fluid may develop around the implant site. I recommend that my patients see me once a year in follow up, or more often if there is a change, so that I can examine the implants and the surgical site. The FDA also recommends that patients get an MRI after five to six years and every two to three years after that to check the implants for rupture.

The only person who can ultimately decide what reconstruction option is right for you, is you. There are various techniques, which give women more choices to restore their shape after mastectomy. The main reconstructive options involve either using a tissue expander/implant or using your own tissue, muscle and skin from another part of your body to rebuild the breast using a flap technique. The most common flaps use a portion of a patient’s abdominal muscle, tissue and skin (the Transverse Rectus Abdominus Muscle or TRAM flap), or using the muscle from the back (Latissimus Dorsi Flap) along with an implant for volume to recreate the appearance of a breast. Other techniques involve removing tissue completely and then re-establishing a new blood supply (free flap reconstruction). Each surgery has its own risks and benefits, so discuss how these relate to you with a board certified plastic surgeon.

Each option can be performed either during the mastectomy surgery as an “immediate” reconstruction, where the process is started at the time of the mastectomy, or later as a “delayed” reconstruction months to years after having a mastectomy. The right choice varies for each woman, depending upon your lifestyle, treatment plan, body type, general health, and your goals. You will work with your plastic surgeon to determine the best individualized plan.

No. It is never too late to consider reconstruction. I have performed a breast reconstruction more than ten years after my patient’s mastectomy. The reconstruction process is very personal and it is important that the timing and pace works for you.

This is important information, because nationwide, a staggering 5 out of 10 mastectomy patients are not told that they have the option of reconstruction. For these women, delayed reconstruction may be an option to close the loop on a process that started years earlier.

In terms of a game plan for treatment, you and your surgeon should discuss the different options for treatment (see the question above) and the timing of the surgeries (whether you should have immediate or delayed reconstruction). This will help you to create a personalized treatment plan that best suits your health, lifestyle and goals.

Yes. Fat transfer is a common part of secondary breast surgery. After permanent implants have been placed or a TRAM flap has been performed, fat transfer can smooth out irregularities or soften transitions from implants to the native chest. Most commonly, I will use belly fat for this procedure. Since this is a part of breast reconstruction, it should also be covered by health insurance.

In 1992, the FDA took silicone breast implants off the market for cosmetic use. They remained available for women who needed breast cancer reconstruction during that time. In 2006, the FDA determined that silicone implants were safe and allowed them back on the market for general use for women over age of 22. The vast majority of studies and research done on silicone during that time confirm that silicone implants pose no additional risk over saline implants.

In August 2019, the FDA stated: “to protect individuals from the increased risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), associated with Allergan BIOCELL textured breast implants, the Food and Drug Administration (FDA) requested that Allergan recall its BIOCELL textured breast implants and tissue expanders. Allergan agreed and is removing these products from the global market.”

If the safety of silicone implants is a concern, we invite you to do research of your own. It is our opinion, however, based on research and education, that medically and scientifically, silicone breast implants pose no significant additional risk.

If you have concerns about your surgical results, without question, the first thing you should do is go back and talk to your surgeon. Have an open and honest conversation about what bothers you and the two of you should be able to develop a plan to help meet your expectations.

Perhaps the most important way to help you be satisfied is to have a conversation with your plastic surgeon before your surgery to create realistic expectations of what surgery and reconstruction can do for you. The goal of most reconstructions is to make the patient appear and feel normal in clothes and a bathing suit. Reconstruction surgery is not the same as a breast augmentation, and the results will not look the same. In addition, you will not have the same sensation that you used to, and you will likely have scars on your breasts. Having said that, however, there are many options and results are better than they have ever been.

A flap reconstruction may sag or droop just as your native breast may over time. It will respond to weight changes as your body does, but this can be variable, again leading to potential changes in the relative appearance of the breast.

No one can guarantee your results. You can, however, ensure that your doctor has had the right training, by confirming that s/he is board certified by the American Board of Plastic Surgery. Although many physicians claim to be board certified, you should confirm their specialty. In addition, you can gain comfort if your doctor is a member of the American Society of Plastic Surgeons (ASPS). The ASPS confirms plastic surgeons’ background training and education. In addition, they ensure that the doctor keeps up on the latest medical developments and research.