Breast Reconstruction Without Implants

If you’ve had a mastectomy and want breast reconstruction, you may be able to use your own body tissue, rather than implants.

When you use your own tissue, it’s commonly called a flap procedure. It moves healthy tissue from one area of the body to the chest. Talk with your doctor to find out if this is an option for you.

What Are the Benefits of Breast Reconstruction Without Implants?

The shape, feel, and contour of a breast reconstructed from a woman's own tissue more closely resembles the characteristics of a natural breast.

What Are the Challenges?

Flap surgery is more involved than implant surgery. And, like all major surgeries, you could have complications, such as bleeding, infection, or poor healing.

Flap procedures require a longer hospital stay than implant surgery; on average 5 to 6 days versus 1 or 2 days for an implant.

It leaves scars in the area the tissue is taken from, but they fade over time.

Where Does the Tissue Come From?

The most common flap procedure uses muscle and skin taken from the area below your belly button and above your pubic bone. Muscle, skin, and fat are moved from your belly to your chest. After the flap of tissue is transferred, the surgeon shapes it into the contour of a breast.

If taking tissue from your stomach isn’t right for you, the surgeon may use tissue from your back -- or even your bottom -- to make the new breast.

How Is the Flap Procedure Done?

There are two basic methods for the reconstruction:

Pedicle or tunneling procedure. With this technique, the section of tissue being moved stays attached to its blood supply. The flap has a better chance of surviving because the blood supply remains intact, but the breast may not look the way you want.

Free-flap procedure. With this technique, the tissue being moved is disconnected from its blood supply and then reconnected to vessels in its new location using microsurgical techniques. This is a more complicated procedure. The biggest risk is that the blood vessels may get clogged and the flap might die. The benefit is that the reconstruction looks more like a natural breast.

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Follow-up Care

You can expect some soreness, swelling, and bruising for 2 to 3 weeks. You may need to put medications on the suture area or change bandages at home. Your surgeon will advise you about showering, bathing, and wound care.

Most women return to normal activities within 6 weeks of their surgery. It may be several weeks before you can do strenuous exercise.

Both mastectomy and breast reconstruction surgery will leave areas of numbness. Instead of feeling pain at the reconstruction site, it may feel numb. The same is true of the area where the tissue was taken. In time, some feeling may return in both sites.

Most scars fade over time, and the shape of your reconstructed breast will slowly improve over the months following your surgery.

What Side Effects Can I Expect?

  • Infection at the surgery site. As with any surgery, infection is a risk. Typically, an antibiotic will get rid of the infection.
  • Pain and discomfort. Your doctor will advise you on a pain relief medication. Some women have more pain than others.
  • Itching. As the wound heals, you will experience itching. But no matter how strong the urge, avoid scratching it. Your doctor can recommend an ointment or cream to calm the itching.
  • Numbness or tingling sensations. You may feel these sensations because the nerves have been affected. It can last up to 12 months after surgery.
  • Fluid collection under the wound. Fluid may collect under the wound. This may happen even after your drainage tubes are removed several days after the operation. If there’s not a lot of fluid, it may go away by itself. But if there’s a lot, your surgeon may have to drain the site using a needle and syringe.

Call your doctor immediately if you have any of the following:

  • A fever above 100 F
  • Fluid leaking from incision sites
  • Any change in color in the breast or scar area

Can the Cancer Come Back?

Breast reconstruction does not affect the chance of the cancer returning. After breast reconstruction, you’ll continue to need regular screening tests.

If it returns, it can be treated by any of the standard treatments, which include surgery, radiation, chemotherapy, and biologic therapy.

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Will My Insurance Cover This?

Reconstructing the breast isn’t considered a cosmetic procedure. Rather, it's part of the treatment for a disease. The Women’s Health and Cancer Rights Act says that insurers must provide coverage for breast reconstruction.

But each policy will vary in its coverage, so it's important that you know the details of your plan.

WebMD Medical Reference Reviewed by Stephanie S. Gardner, MD on August 11, 2017

Sources

SOURCES:

American Society for Plastic and Reconstructive Surgeons: “Breast Reconstruction.”

Breast Cancer.org: “Screening After Breast Reconstruction,” “TRAM Flap,” ”TRAM Flap Reconstruction: What to Expect.”

American Cancer Society: “Types of breast reconstruction,” ”Breast Reconstruction After Mastectomy.”

Cancer Research UK: “Breast reconstruction using body tissue.”

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