The Autologous Advantage

While there are numerous techniques available for breast reconstruction, the currently available approaches can be broadly classified into two categories: implant-based procedures and autologous reconstruction. The latter utilizes a patient’s own tissue to reconstruct the breast and has been shown to provide many potential benefits for women who choose this option.

Implant Reconstruction

Implant reconstruction is commonly performed and is highly successful in many cases; however, for some patients, this approach is not considered satisfactory. The reasons for dissatisfaction are varied. A number of patients who have undergone radiation therapy or who develop extensive scar tissue around their implants often report asymmetry, pain, tightness, or generalized discomfort. Other patients develop asymmetry over time, as the implants do not adjust to body changes such as weight gain or loss. This necessitates the need for external prostheses or mastectomy bras. A small subset of patients find it challenging to fully accept their implants emotionally as part of their bodies, despite a relatively normal appearance or reasonable symmetry, and report that they are constantly aware of their implants. In many cases, these women seek additional options for reconstruction.

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Autologous Reconstruction

Recent studies conducted by Memorial Sloan Kettering Cancer Center (MSK) indicate that conversion to the use of a patient’s own tissue for breast reconstruction provides a strong alternative for many women. In autologous reconstruction, excess adipose tissue from the abdomen, thigh, or buttock areas is transferred to the breast using microsurgical techniques. The tissue is then sculpted to restore the natural shape and volume of the breast. Any accumulated scar tissue surrounding the implant can be removed simultaneously.

This approach enables surgeons to create a custom-made breast, providing better symmetry to the contralateral breast. In addition, the use of a patient’s own tissue prevents the recurrence of scar tissue. Unlike implants, tissue is placed under the skin rather than under the pectoralis muscle, providing a more natural look and feel. Because these techniques use living tissue, the reconstructed breast grows naturally with the patient if she gains or loses weight. Women who undergo autologous reconstruction consistently report a high rate of satisfaction, even many years following the procedure.

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 Advances in Microsurgery

With recent advances in microsurgery, autologous reconstruction has also become a viable option for thinner patients, boasting high success rates (>99%) and rapid recovery.(1-5) Only ten years ago, these microsurgical procedures took as long as six to eight hours to perform. Today, the length of such procedures has decreased substantially, equating to less postoperative pain and shorter hospital stays.

Given the strides made in this approach and the positive outcomes reported, conversion to autologous tissue reconstruction offers an excellent alternative for patients who are physically dissatisfied with their current reconstruction, or who suffer from pain or discomfort.

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  1. Albornoz, C.R., P.G. Cordeiro, G. Farias-Eisner, B.J. Mehrara, A.L. Pusic, C.M. McCarthy, J.J. Disa, C.A. Hudis, and E. Matros, Diminishing relative contraindications for immediate breast reconstruction. Plast Reconstr Surg, 2014. 134(3): p. 363e-369e.

  2. Antony, A.K., B.M. Mehrara, C.M. McCarthy, T. Zhong, N. Kropf, J.J. Disa, A. Pusic, and P.G. Cordeiro, Salvage of tissue expander in the setting of mastectomy flap necrosis: a 13-year experience using timed excision with continued expansion. Plast Reconstr Surg, 2009. 124(2): p. 356-63.

  3. Avraham, T., N. Clavin, and B.J. Mehrara, Microsurgical breast reconstruction. Cancer J, 2008. 14(4): p. 241-7.

  4. Chen, C.M., E.G. Halvorson, J.J. Disa, C. McCarthy, Q.Y. Hu, A.L. Pusic, P.G. Cordeiro, and B.J. Mehrara, Immediate postoperative complications in DIEP versus free/muscle-sparing TRAM flaps. Plast Reconstr Surg, 2007. 120(6): p. 1477-82.

  5. Mehrara, B.J., T.D. Santoro, E. Arcilla, J.P. Watson, W.W. Shaw, and A.L. Da Lio, Complications after microvascular breast reconstruction: experience with 1195 flaps. Plast Reconstr Surg, 2006. 118(5): p. 1100-9; discussion 1110-1.