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.
Most women return to normal activities within six weeks after surgery. It may be several weeks before you can do strenuous exercise. After you go home, you can expect some soreness, swelling and bruising for two to three weeks. You may be asked to apply medications to the suture area or change bandages at home. Your plastic surgeon will advise you about showering, bathing and wound care.
Mastectomy and breast reconstruction surgery will leave areas of numbness where the surgery was performed. Instead of feeling pain where the tissue was taken, a patient may feel numbness and tightness. The same is true of the reconstruction site. In time, some feeling may return in your breasts. Most scars will fade over time.
The shape of your reconstructed breast will gradually improve over the months following the reconstruction.
You'll be asked to return for regular checkups at first. If you have a temporary expander implanted, it will be expanded with saline on average once a week until the desired size is obtained (usually within six to ten office visits).
After breast reconstruction, you should continue to examine your breasts every month. You should continue to have regular screening examinations, such as an annual mammogram.
Breast reconstruction has no bearing on cancer recurrence or surveillance, and generally does not interfere with chemotherapy or
radiation treatment. A recurrence can still be treated by any of the standard treatment methods, which include surgery, radiation and chemotherapy. In addition, reconstruction rarely, if at all, hides or obscures a local recurrence.
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Questions to Ask Your Doctor About Breast Reconstruction
You may want to ask your doctor these questions about breast
- Which type of surgery would give me the best results? How will I
- When can my reconstruction begin?
- How many surgeries will I need?
- What are the risks at the time of surgery? Later?
- Will I have scars? Where? What will they look like?
- If tissue from another part of my body is used, will there be
any permanent changes where the tissue was removed?
- What activities should I avoid? When can I return to my normal
- Will I need follow-up care?
- How much will reconstruction cost? Will my health insurance pay
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What Side Effects Can I Expect?
- Infection at 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. The level of pain and discomfort will vary from person to person.
- Itching. As the wound heals, you will experience itching. No matter how much the area may itch, you should avoid scratching it. Your doctor can recommend an ointment or cream to use at the site to reduce this effect.
- Numbness or tingling sensations. You may experience these sensations because the nerves have been affected. This side effect can last up to 12 months after surgery.
- Fluid collection under the wound. Sometimes, one of two types of fluid may collect under the wound: seroma (fluid under flap) or hematoma (blood). This may happen even after your drainage tubes are removed several days after your operation. If the fluid collection is small, it may go away by itself. However, if the fluid collection is large, your surgeon may have to drain the site using a needle and syringe.
After Your Surgery, Contact Your Doctor Immediately Should You Experience Any of the Following:
- A fever above 100 degrees
- Fluid leaking from incision sites
- Any change in color in the breast or scar area
Does Insurance Cover Breast Reconstruction Without Implants?
Reconstructing the breast is not considered a cosmetic procedure. Rather, it's part of the treatment for a disease and the Women's Health and Cancer Rights Act mandates that insurers provide coverage for breast reconstruction.
However, each carrier will vary in its coverage, so it's important that you familiarize yourself with the details of your plan.
WebMD Medical Reference
Reviewed by Michael J. Wheatley, MD, on February 28, 2010