Natural Breast Reconstruction

In the early days of breast reconstruction, patients were limited to implants. More recently, however, a number of techniques have been developed that involve using the patient’s natural tissue, fat, and even blood vessels to build the new breast(s). These procedures, collectively, are called natural breast reconstruction, and offer a more natural look and feel than implants. They are becoming an increasingly popular choice among women looking for breast reconstruction surgery. Following is an overview of natural breast reconstruction and some factors to consider when choosing a breast reconstruction procedure for yourself.

What is natural breast reconstruction?

Natural breast reconstruction, also known as natural tissue breast reconstruction, is a set of procedures that uses the patient’s own tissue to construct the new breast(s). This tissue takes the place of implants – although occasionally, both implants and natural tissue will be used. The tissue used in the natural breast reconstruction is borrowed from another area of the patient’s body. The most common areas are the abdomen, the buttocks, and the inner or posterior thigh. The tissue moved might include just skin, fat, and blood vessels, or it might also include muscle. This tissue is called a “flap.” Advanced natural breast techniques involve completely removing the flap and transferring it to the breast area, where the blood vessels are reconnected via microsurgery. These surgeries are also known as Free Flap procedures because the flap is completely separated from the body before being transferred to the breast area. Newer than the original flap procedures, free flap surgeries tend to be more specialized and require training in microsurgery. However, they also tend to produce the most natural results, with the fewest side effects.

What procedures are included in natural breast reconstruction?

Natural breast reconstruction includes a number of techniques.

  • DIEP flap  (Deep Inferior Epigastric Perforator):

DIEP flap surgery is one of the most advanced forms of natural breast reconstruction. This procedure involves removing the excess skin and fat from the abdominal area for use in reconstructing the breast.  Unlike the older TRAM procedure, the DIEP flap surgery is a free flap technique that does not remove a patient’s important abdominal muscles.  DIEP flaps surgery maintains a woman’s core muscle strength. DIEP flap surgery is sometimes compared to a “tummy-tuck” because the outward result is a flattened and tightened abdomen.

  • SGAP (Superior Gluteal Artery Perforator):

This advanced procedure involves removing skin and fat from the upper buttock for use in breast reconstruction. Similar to DIEP flap surgery, muscle is not included in the flap. One downside of this surgery is that a surgery to the other buttock may be needed to restore symmetry.

  • PAP (Profunda Artery Perforator):

This advanced procedure involves transfer of excess skin and fat from the upper posterior thigh, just beneath the buttock. Similar to DIEP flap surgery, muscle is not included in the flap. One downside of this surgery is that a surgery to the other thigh may be needed to restore symmetry.

  • TUG (Transverse Upper Gracilis):

This advanced procedure involves transfer of excess skin and fat from the upper inner thigh. Similar to DIEP flap surgery, muscle is not included in the flap. One downside of this surgery is that a surgery to the other thigh may be needed to restore symmetry.

  • Lat Flap (Latissimus Dorsi Myocutaneous):

In this procedure, skin, muscle and fat from the upper and middle back, are rotated to the breast area. Like the TRAM procedure, this surgery involves muscle and may result in a decrease in strength with activities such as climbing, overhead pulling, and swimming.

  • TRAM flap (Transverse Rectus Myocutaneous):

This flap procedure involves moving muscle, in addition to skin and fat, from the abdominal area to the breast area. This procedure removes part or all of a women’s core rectus muscles, causing weakness and increased risk for hernia formation. It is no longer a preferred method of natural breast reconstruction.

  • Fat Grafting

This procedure involves removing fat through liposuction of the abdomen, thighs, buttocks, back or arms. This fat is then prepared and gently injected into the breast to increase overall volume or soften the appearance of contour irregularities after surgery to remove a cancer or reconstruct a breast. Some downsides of this surgery are:

  • The grafted fat may become hard and require biopsy.
  • The grafted fat will partially resorb and several sessions of fat grafting may be needed over a period months to achieve the desired results.

What are the advantages of natural breast reconstruction?

Natural breast reconstruction is a more complex procedure than implant- based reconstruction and should be performed by a plastic surgeon trained in these techniques. However, natural breast reconstruction presents a number of advantages that make it an appealing option for many women. In particular, free flap procedures, such as DIEP flap surgery, minimize complications such as muscle weakness and asymmetry and provide significant improvements for the patient.  Here are a few of the main advantages of natural breast reconstruction surgery:

Natural Look

Natural breast reconstruction, as its name implies, allows for a natural look and feel to the breast. Because the procedure uses your own tissue, the reconstructed breast looks and feels much like your old breast did. Many women do not want to appear as though they have had a breast augmentation, and natural breast reconstruction can achieve that. In some cases, especially when nipple sparing techniques are used, the appearance of the breast is actually improved. In addition, the tissue ages similarly to the rest of your body, allowing you to retain a natural look throughout your lifetime.

No Repeat Procedures

Implants are medical devices and should be replaced every 12 years, requiring repeat operations over a woman’s lifetime. Additionally, implants may rupture or become infected.  Natural breast reconstruction, however, lasts a lifetime and does not include material foreign to a woman’s body. The naturally reconstructed breast ages naturally without the need for further surgeries.

Natural Feel and Symmetry

In addition, natural breast reconstruction is preferred by many women because it allows the plastic surgeon to sculpt a breast that is the size, shape and feel of her natural breast. For women who only need one breast reconstructed, this can mean a much more seamless look when the procedure is finished.

How do I choose between implants and a natural breast reconstruction procedure?

Natural breast reconstruction offers many advantages, however, the procedure is not the right fit for every patient. The best way to make the decision regarding which type of breast reconstruction procedure is the right one for you is to consult with your experienced plastic surgeon. During your consultation, your reconstructive plastic surgeon will go over all of the factors you need to consider in order to make a decision. For example, your body type might make you more or less qualified for a certain procedure (extra abdominal tissue makes for an easier DIEP flap surgery for instance, while thinner women might do better with implant-based reconstruction or a stacked DIEP procedure). Your health history, personal preferences, whether you are having one or both breasts reconstructed, as well as other considerations, all play a role in the decision you will ultimately make. Natural breast reconstruction offers you the chance to have a natural looking and feeling breast by using your own tissue to rebuild the breast. In particular, DIEP flap surgery can provide you with a natural breast without the complications that accompany other forms of breast reconstruction surgery. However, in order to determine the best method for you, consult with your surgeon. If you are interested in breast reconstruction surgery, and particularly in DIEP flap surgery, contact Dr. Potter today.