Women More Satisfied When Breast Reconstruction Uses Their Own Tissue
Published on October 26, 2023
Women who had breast reconstruction using their own tissue – called autologous or flap reconstruction by doctors – reported more satisfaction with their breasts in the short term than women who had implant reconstruction, according to a study.
The research was published in a special October 2023 supplement to the journal Plastic and Reconstructive Surgery. Read “Short-Term Quality of Life after Autologous Compared with Alloplastic Breast Reconstruction: A Prospective Study.”
How a breast is reconstructed
There are two main ways to reconstruct a breast. One technique uses implants – silicone shells filled with gel or saline (salt water). The other type uses a flap of tissue from another place on your body. The tissue, or flap, usually comes from:
the belly
the buttocks
the thighs
the back
under the arms
In some cases, the surgeon uses both a flap and an implant to rebuild the breast.
Flap reconstruction surgery is longer and more complex, involves more incisions and a higher risk of complications, and has a longer recovery time than implant reconstruction surgery because there are two surgery sites.
Still, implant reconstruction surgery has some drawbacks, including a risk of breast-implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare type of T-cell lymphoma (cancer of the immune system), if textured implants are used. You also have to have implants replaced every 10 years or so.
About the study
Because flap reconstruction surgery is harder on your body, the researchers who did this study wanted to know if quality of life was worse in the six months after surgery compared to women who had implant reconstruction.
The Dutch study included 138 women who had either flap or implant reconstruction between 2012 and 2019 at three hospitals in the Netherlands:
75 women had implant reconstruction
63 women had flap reconstruction
All the women filled out questionnaires that asked about their physical health, their satisfaction with their breasts, and their emotional health three times during the study:
before breast reconstruction surgery
six weeks after breast reconstruction
six months after breast reconstruction
Of the women who had implant reconstruction:
67% had two-stage breast reconstruction, meaning they had tissue expanders placed in the first surgery; after the expanders had stretched the skin to the correct size, a second surgery removed the expanders and placed the implants
25% had one-stage breast reconstruction, meaning the implants were placed during the first surgery
8% had latissimus dorsi flap (back muscle) and implant reconstruction
All the women who had autologous reconstruction had DIEP flap (belly tissue) reconstruction.
Women who had implant reconstruction:
had a lower body mass index (BMI)
were younger
were more likely to smoke
were more likely to have some type of heart disease
Before breast reconstruction, women who were going to have flap reconstruction were slightly less satisfied with their breasts than women who were going to have implant reconstruction, based on their survey answers.
Women who had flap reconstruction had more than twice the rate of grade III or higher complications:
27% of women who had flap reconstruction had a grade III or higher complication
12% of women who had implant reconstruction had a grade III or higher complication
Because the women who had flap reconstruction were less satisfied with their breasts before surgery and had more severe complications, the researchers expected them to be less satisfied with their breasts after surgery. But they were wrong.
Women who had flap reconstruction were actually more satisfied with their breasts than women who had implant reconstruction both six weeks and six months after surgery. Women who had flap reconstruction also had higher psychosocial and sexual well-being survey scores.
Women who had one-stage implant reconstruction had higher breast satisfaction scores than women who had two-stage implant reconstruction.
"The findings were unexpected, since autologous breast reconstruction is a more complex procedure, with a higher rate of severe complications," lead author Nadia Sadok, MD, PhD, of University Medical Center Groningen, in the Netherlands, said in a statement. “It is possible that the differences in preoperative scores is not merely explained by the timing of reconstruction but that [they are] also related to body type and related to self-perceived body image and body satisfaction.”
What this means for you
Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. If you’ve been diagnosed with breast cancer and are planning your surgery, you may decide not to have reconstruction, but it can be helpful to consider all your options.
It’s very important that you understand the outcomes of the type of reconstruction you’re considering, including the risk of complications and the effects on your quality of life.
There are advantages and disadvantages to both implant reconstruction and autologous reconstruction. Implant reconstruction is considered easier up front, but usually requires another surgery after 10 or more years. Autologous reconstruction is a more involved surgery, with higher rates of complications and a longer recovery time, but as this study shows, it offers better patient satisfaction. You will need to decide what is right for you and your unique situation.
Here are some questions you might want to think about as you're making decisions about breast reconstruction:
Is it important to you to have a permanent breast shape? Some women prefer to wear a prosthesis instead of having reconstruction.
Is it important to you that your breasts look balanced when wearing a bra and bathing suits? Though you'll be able to see the difference between the rebuilt breast and your other breast when you're naked, reconstruction usually looks very natural when you're wearing a bra or bathing suit.
In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes.
Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover.
Did you have a lumpectomy that gave your breast a very different shape than it originally had? If you had a large portion of tissue removed, you might want to have reconstruction to restore a more balanced look.
Do you have any other medical conditions that might affect your ability to heal after surgery? If you have diabetes, circulatory problems, or a bleeding disorder, it may take your body longer to heal from reconstruction surgery than someone who doesn't have these conditions.
Do you have a condition that might give you a distorted image of your body? If you've been diagnosed with anorexia or bulimia, you may have a hard time accepting how your body looks in general, which may make it hard to accept how your reconstructed breast looks.
