AUTOLOGOUS TISSUE RECONSTRUCTION - Orange County, CA
What is Autologous Tissue?
Autologous Breast Reconstruction is the process of reconstructing your breasts by using your own tissue (abdominal, thigh, or back tissue). There are many different surgical procedures that fall under this category, which we will discuss.
Who is a Good Candidate for Autologous Breast Reconstruction?
Patients must first have adequate tissue to be able to recreate the breast or breasts. Most often, tissue will be taken from the abdomen, using tissue that is normally thrown away during a tummy tuck. If you don't have enough tissue, it may be combined with implants to provide enough volume and create a more aesthetic result.
Patients who do not want breast implants inside their body should also consider autologous breast reconstruction. Breast implants are at higher risk of infection and require maintenance over the years, including replacement every 10 years. Some patients aren't okay having to undergo multiple surgeries for the rest of their lives, so they opt not the have implants.
Although autologous reconstruction does not require multiple small surgeries over your lifetime, it does require that you undergo one large surgery at the beginning of that journey. This requires a much longer and tougher recovery than with breast implants, and so patients must be in relatively good health and be able to tolerate long surgeries.
Patients who will need radiation as part of their treatment plan are also better candidates for autologous breast reconstruction. Using implants in these patients puts them at much higher risk for implant extrusion and infection.
What is Involved in Breast Reconstruction using Autologous Tissue?
Several areas in the body have enough tissue to be able to donate to recreate a breast. These areas include the abdomen, the thighs, the buttocks, and the back.
The abdomen is the most common area used to transfer tissue to the chest for breast reconstruction. Most of the tissue from the lower and mid-abdomen (the same tissue removed in a tummy tuck) is elevated and left attached only by its blood supply through the rectus muscles (the six-pack abs). This is called a TRAM (Transverse Rectus Abdominis Muscle) reconstruction. The muscle and the attached skin and fat are swung underneath the upper abdominal and lower chest skin and sewn into place where the new breast will be located.
Sometimes, your surgeon can leave the muscle in place, and elevate the skin and fat on a single blood vessel. That blood vessel is then transferred up to your chest and reattached to the blood vessels under your ribs with the help of a microscope. This is known as a DIEP (Deep Inferior Epigastric Perforator) Breast Reconstruction.
A similar procedure can be done by taking the skin, fat, and muscle from the inside of the thighs, posterior thighs (under the buttocks), or the buttocks themselves. Additionally, the latissimus dorsi muscle with its overlying skin and fat can be used as well. However, the latissimus tissue usually doesn’t have enough volume on its own and is used with a tissue expander or implants at the same time. These other choices are more complicated and should be discussed with your plastic surgeon directly.
What is the Recovery Like After Autologous Breast Reconstruction?
The recover is usually tougher than what it is with implant-based reconstruction. Most patients will be off work from 4 to 6 weeks. You will experience some pain and soreness in your new breast as well as in the donor site. The tissue donor site (abdomen/thigh/buttocks/back) will usually need a compression wrap for 6 weeks in order to prevent swelling and fluid buildup.
You will likely have drains in the donor site that will be removed over the course of several weeks as the volume of fluid decreases. If your rectus muscle is taken with the tissue to reconstruct your breast, you may need some physical therapy in order to rebuild your strength as well as to learn how not to stress that area of your abdomen from now on.
However, once you are fully healed, usually you will only need a nipple reconstruction surgery to match your other breast! This reconstructed breast will continue to sag over time like your natural breasts, unlike implants which tend to stay in a higher position for much longer.
What are the Risks of Autologous Breast Reconstruction?
Risks of this surgery include bleeding and infection, just as with any other surgery. However, the risk of infection is lower than in implant-based breast reconstruction because there is no prosthesis inside your body.
Because the surgeries tend to be much longer and more involved, there is a higher risk of developing blood clots in your legs that may travel to your lungs and cause respiratory problems. Because of this, blood thinners are usually given to you prior to surgery and after surgery, which may increase the risk of surgical bleeding.
If there are issues with the blood vessels becoming kinked or clotted, the entire portion of the transferred tissue may die. Usually, emergent surgery is done to try to save that tissue, but if that fails, you may need to start the reconstructive process again with a different surgery.
Taking the rectus muscle with the tissue used to reconstruct your breast may leave your abdominal wall weaker and more prone to hernias. Usually, a mesh will be used to reinforce the abdominal wall where the muscle is missing, but a ventral hernia may still develop over time. Some surgeons will use less of the muscle and leave some behind to help reduce the risk of a hernia (also called a muscle sparing-TRAM).
Occasionally, the reconstructed breast may be asymmetric compared to the other breast, and a revision surgery will be needed. If not enough tissue is obtained during the reconstruction, breast implants may have to be added later to supplement the volume.
Numbness of both the donor site and the reconstructed breast may also occur. This may resolve in the donor site over weeks or months. It may be permanent in the breast if a donor nerve is not reconstructed as well.
Breast reconstruction can be a daunting process, so we recommend that you read and do as much research as you can on your own before coming to speak to your plastic surgeon in more detail. We wish you the best and pray for your health and safety on this journey. God Bless!
Learn more about the alternative to Autologous Based Breast Reconstruction here.