Breast Reconstruction: Choosing What Type

Patient Expert

Once you decide to have breast reconstruction surgery, you need to choose which type: saline/ silicone implants, or surgery using your own body tissue (autologous reconstruction). Here are the details on each that'll help you make your best decision.

Q. I've heard there are lots of different choices for reconstruction. Can you summarize the basics?

A. Sure. They boil down to two main choices, each with a number of variations.

-Implant: This is by far the most common procedure women have to build a new breast. A silicone or saline-filled sack is placed behind your chest muscles, then muscle and skin are pulled over the sack and the incision closed up.

-Autologous (body tissue) reconstruction: A part of your body (fat and often muscle, plus blood vessels) is surgically "rearranged" into the space left by your mastectomy; or part of your body is cut off, moved, and reattached at the site of your mastectomy. In either case, skin is pulled over the muscle/fat and sewn closed.

Note: If you're a smoker, it's just about certain your surgeon will refuse to perform any autologous reconstructive surgery. Due to smoking's effect on blood circulation, the risk is simply too great that the procedure will fail, due to insufficient blood flow. In addition, you're probably not eligible for autologous reconstruction if you have diabetes, or connective tissue or vascular disease.

Q. What's the best kind of reconstruction?

A. The very best reconstruction is the one that makes you happy. And only you can decide that. Here are some pluses and minuses for both types:

-Implant pluses: The initial surgery and resulting recovery time are both much shorter than that for body tissue reconstruction, and there's a reduced risk of complications. The operation is also less expensive. There are many surgeons who know how to perform implant surgery, so it shouldn't be difficult to find one to do your operation, nor should it take too long to schedule.

-Implant minuses: Implants usually don't look as natural as body tissue reconstruction. They're stiffer, and don't hang the same as your other breast. Having radiation after getting an implant can increase the risk of complications with the implant. Saline implants may leak or rupture, and they have a limited lifespan, requiring further surgery for replacement down the road. In addition, implants make your regular screening mammogram a longer process, as additional shots have to be taken  to "see" around the implant.

Finally, implant surgery is often a two-step process, with surgeries scheduled months apart. Multiple surgeries mean additional chances for complications, and more recovery periods.

-Body tissue reconstruction pluses: In general, a body tissue reconstruction will look more natural than an implant. It'll match your other breast more closely, and hang like a normal breast. There's much less chance of further surgery down the road. You can have radiation after surgery without any ill effects.

And here's my personal favorite: Body tissue reconstruction takes fat from another part of your body to construct a new breast. So not only do you get a new breast - you get a possible tummy tuck, thigh reduction, or a slimmed-down posterior

-Body tissue reconstruction minuses: The surgery is long and arduous, and the recovery time longer than that for an implant. You'll have more scars (one around the new breast, one at the site where they removed the reconstruction tissue). The surgery is also more expensive.

In addition, there are fewer plastic surgeons who do the procedure, so it may be difficult to find one to operate on you, or challenging to get a surgery date.

The good news is, this isn't a decision you'll have to make by yourself. Unlike much of the breast cancer experience, where you're asked to make decisions (e.g., lumpectomy or mastectomy), in the case of reconstruction you'll probably have lots of advice from your healthcare providers. They'll assess your body type, and recommend what they think would be best for you.

Not to say you have to blindly accept their recommendation; if you disagree, fight for what you want, or find another surgeon. But it's nice to be able to throw an informed opinion into the mix when you're trying to make yet another difficult decision about your cancer treatment.

Read more:

Breast Reconstruction: Yes or No?

Breast Reconstruction: Implants

Breast Reconstruction: Body Tissue (Autologous) Reconstruction

Choosing a Prosthesis or Breast Form