How difficult is it to “go flat” after implant surgery?

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momten asked:

I had bilateral mastectomy with implant reconstruction about a year ago. The implant exchange was done 3 months ago. I am very unhappy with the silicone implants, although they look fine and healed well.

My question is: If I choose to have the implants removed and to “go flat,” how difficult is that surgery? Will the function of the pectoral muscles ever be back to normal? Are the Alloderm grafts removed? How is the excess skin/tissue handled?

My plastic surgeon has never removed implants and so can't answer these questions.

Answer:

I’m sorry that you are having difficulties with your implant breast reconstruction. We see a large volume of patients who have a variety of symptoms from implant reconstructions. Some report “animation” where the breast moves around when they contract their pectoralis muscle. Others report discomfort, tightness, cold feeling, and other problems related to the shape or size of the implants. Many of these problems can be improved with a revision. Alternatively, many of our patients seek to have their implants out and replaced with autologous/flap reconstruction. Invariably the flap reconstructions look and feel more natural. The implants are removed, the pectoralis muscle is returned to its natural position and the reconstruction is done in the same location that the breasts were prior to the mastectomy — above the muscle.

However, if you want to “go flat,” that is easily accomplished. The implant and cellular dermal matrix (Alloderm) are easily removed. Some of the excess skin is removed as well. The muscle is returned to its natural position and function should improve. Seek out a reconstructive plastic surgeon specializing in breast reconstruction and offering both implant and autologous perforator flap breast reconstruction.

— M. Whitten Wise, M.D.


M. Whitten Wise

M. Whitten Wise, M.D.

Dr. Wise is part of the reconstruction team at the Center for Restorative Breast Surgery in New Orleans, Louisiana. Learn more about Dr. Wise.


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