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Cosmetic Procedures: Breast Reconstruction Without Implants

Women who have had breast cancer and a mastectomy have a number of options in breast reconstruction. If the woman does not want implants, she may choose to have her breast reconstructed using her own body tissue through what is commonly known as a flap procedure. This operation involves moving healthy tissue from one area of the body to the chest using one of two methods, tunneling or free-flap.

  • Tunneling procedure. Using this technique, the transplanted section of tissue remains attached to its original blood supply. The surgeon tunnels the section of tissue under the skin and places it at the reconstruction site.
  • Free-flap procedure. Using this technique, the tissue is disconnected from its original blood supply and then reconnected, using microsurgical techniques, to an existing blood supply in the chest area.

Where Does the Tissue Come From?

While tissue from the back or buttocks may be used, the most common flap procedure uses muscle and skin taken from the abdomen. Using either the tunneling or free-flap technique, muscle, skin, and fat are transplanted from the abdomen to the chest area. After the flap of tissue has been transferred, the surgeon shapes it into the contour of a breast.

When the abdominal flap is not an option, the surgeon may use tissue from the back -- and, less often, the buttocks -- in making the new breast.

What Are the Benefits of a Getting a Breast Reconstruction Without Implants?

Using one's own tissue and muscle results in a more natural looking breast that is not vulnerable to the problems that sometimes occur with implants. The shape, feel, and contour of a breast reconstructed from a woman's own tissue more closely resemble the characteristics of a natural breast.

Transferring tissue from the abdomen also results in tightening of the stomach resembling a tummy tuck.

What Are the Challenges of These Procedures?

Flap surgery is more involved than implant surgery. And, like all major surgical procedures, it carries the risk of complications, such as bleeding, infection or poor healing. However, these complications, should they occur, can be treated at the hospital.

Flap procedures also leave additional scars on the abdomen, back, or buttocks and require a longer hospital stay than implant surgery; on average five to six days versus one or two days for implant recipients. Generally, the additional scars resulting from the flap procedure are well concealed.

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