Why is autologous breast reconstruction better than breast implants?

Women who have a mastectomy often are concerned with how their breast will look and feel after reconstructive surgery. About 80 percent of women choose to get a breast implant after having breast cancer surgery. While this is a great option for some women, it’s not for everyone.

We offer an alternative to implants – autologous breast reconstruction – which uses tissue from a woman’s own body to reconstruct the breast. Nearly everyone is a candidate for this procedure, and I think it should be the standard of care in breast reconstruction.

How does autologous breast reconstruction work?

Autologous breast reconstruction involves rebuilding the breast using only a patient’s own body parts. No artificial breast implants are involved.

Autologous #breastreconstruction involves rebuilding the #breast using only a patient’s own body parts. via @MedStarWHC

While there are several types of flap reconstruction for breasts, we use what’s called a DIEP flap. A DIEP flap uses blood vessels in the abdomen called deep inferior epigastric perforators, as well as the skin and fat connected to these blood vessels. We take these blood vessels, skin and fat and transplant them from the abdomen to the chest, molding them to rebuild the breast.

DIEP flap surgery may be done at the same time as a mastectomy or at a later date, depending on what your doctor recommends and what you prefer.

There are very few patients who aren’t good candidates for this procedure. We may not recommend autologous breast reconstruction if a patient has other health problems, such as heart or lung conditions. These conditions may prevent women from being good candidates for breast implants as well. And, of course, a patient needs enough extra skin and fat for us to transplant to the breast. So, for example, a 5-foot-5-inch woman who’s 98 pounds with D-cup breasts likely wouldn’t have enough tissue to borrow from. But aside from these two extreme types of cases, there aren’t any reasons why someone couldn’t consider autologous breast reconstruction. 

It’s important to talk to your doctor about the pros and cons of a breast reconstruction procedure. Request an appointment with me through our secure online form, or contact me at (202) 444-8751 so we can discuss whether autologous breast reconstruction is right for you.

How a DIEP flap compares to implants

For a woman who’s had a mastectomy, a DIEP flap is the best option, in my opinion. A DIEP flap results in a nice, supple breast that a woman will have the rest of her life. Breast implants, in contrast, only last 10 to 15 years before needing to be replaced in an additional surgery.

A #DIEPflap results in a nice, supple #breast that a #breastreconstruction patient will have the rest of her life. via @MedStarWHC

One potential side benefit of DIEP flap surgery is that patients get a sort of “tummy tuck” effect when we take the skin and fat from the abdomen to build their new breasts. If we can’t take enough skin and fat from the tummy to rebuild a patient’s breast, we can take it from the thighs or buttocks if necessary.

Something to keep in mind is that breast implants aren’t compatible with radiation treatments. This means women with artificial breast implants may have issues if they need to have some forms of diagnostic imaging, such as CT scans or X-rays, as well as future cancer treatment with radiation oncology. These are some potentially serious downsides patients should consider before deciding to go with an implant.

There are small chances of complications or failure in DIEP flap surgeries. Patients have a 0.8 percent chance of getting a hernia from transplanting the tissue from the abdomen. And in rare cases—about 1 out of 100 surgeries—the transplant can fail. Both of these are highly dependent on the skillset of the surgeon. That’s why it’s critical for patients who are interested in autologous breast reconstruction to choose a surgeon who has a great deal of experience with the procedure.

Our expertise with autologous breast reconstruction

My team and I have performed more DIEP flap surgeries than anyone else in the region. Between us, we’ve done somewhere between 3,500 and 4,000 of these technically challenging surgeries. The next-closest group to us in terms of the number of surgeries has only done 800 to 900 of these procedures.

Patients from all over the country who have had mastectomies have come here for reconstruction. In fact, after I moved here from Chicago, my first 12 patients were women who followed me from there because they wanted me to complete their reconstructions.

Every body shape is different. That means each breast we reconstruct is going to be just a little different than all the others. We go over the possibilities with each of our patients, walking them through their options and learning the goals they hope to accomplish with their reconstruction. That’s how we personalize our care and ensure women have an outcome they’ll be happy with for the rest of their lives.

I wish no one had to go through breast cancer. But we have options available to rebuild patients’ breasts after the often painful and difficult process of being treated for the disease. Patients may sometimes feel like they’ve lost their femininity after treatment. But we’re able to help restore their senses of self-esteem and womanhood as they take the steps they need to reclaim their lives. If there’s a silver lining to breast cancer and its treatment, it’s that. And I’m glad to be a part of that process for my patients.

How surgery can improve the lives of patients with lymphedema

There are many options available to patients for treating breast cancer. Unfortunately, a significant portion of patients will face the complication of lymphedema after their treatment. About 20 percent of patients diagnosed with breast cancer will develop lymphedema.

About 20% of patients diagnosed with #breastcancer will develop #lymphedema. via @MedStarWHC

Historically, there hasn’t been much doctors could do for lymphedema. Our treatment options focused on helping people deal with symptoms and adjust to the realities of having this condition, not addressing and eliminating the cause. But we now have surgeries that treat the root cause of lymphedema, not just symptom control.

Lymphedema surgery can open up many possibilities for patients to do things they weren’t able to before. If you want to wear a fancy dress to an event, or if you want to play basketball or a game of tennis, you might not have to wear a compression sleeve anymore.

Dr. David Song discusses lymphedema surgery further on the Medical Intel podcast.

I’m one of the only doctors in Washington, D.C., and the East Coast who offers these advanced surgeries, and I’m happy to talk with patients and their family members about their potential benefits. Request an appointment with me through our secure online form, or contact me at (202) 444-8751 so we can discuss whether lymphedema surgery is right for you.  

What is lymphedema?

Lymphedema is a condition in which lymph accumulates in the body, leading to swelling in the areas where it builds up. Lymph contains white blood cells, which help the body fight infections, as part of the immune system. Lymph vessels carry lymph that drains from the body’s tissues and organs to lymph nodes. Lymph nodes filter lymph and produce more white blood cells.  

There are two kinds of lymphedema: primary lymphedema and secondary lymphedema. Primary lymphedema is a condition people are born with. Patients who have breast cancer may be at risk for secondary lymphedema, which happens when lymph vessels are damaged or blocked because of another condition.  

Treatment for breast cancer may involve the removal of the axillary, or underarm, lymph nodes. Even if these lymph nodes aren’t removed as part of a patient’s breast cancer surgery, they may still be damaged during the procedure. Removed or damaged axillary lymph nodes can keep lymph from draining properly from the arm, which causes the arm to swell.  

Patients who have had any of the following procedures to treat their breast cancer may be at risk for lymphedema if their treatment involved the axillary lymph nodes:

  • Lumpectomy
  • Radiation therapy
  • Simple or radical mastectomy  

If left untreated, lymphedema can lead to bacterial or fungal infections of the skin. Loss of mobility and flexibility in the affected arm are additional risks the condition carries.  

Sometimes the swelling of lymphedema is easy to see. But it’s sometimes more difficult to notice right away. Watch for these lymphedema symptoms if you’ve had breast cancer surgery:

  • Feeling like the arm or hand is too tight, heavy or full
  • Pain or redness in the arm or hand
  • Thickened skin in the arm or hand
  • Tighter fit for shirts, watches or rings

How we treat lymphedema

People who have lymphedema may be able to manage the condition with treatments such as:

  • Compression bandages, pumps or sleeves
  • Physical therapy
  • Special massage techniques  

But if the condition gets worse or doesn’t respond to these treatments, surgery may be a good option.  

In the past, lymphedema surgery was limited to the removal of excess tissue and fluid in the arms. But modern techniques allow us to actually treat a patient’s lymphedema with surgery, rather than just addressing the symptoms. Our microsurgical procedures can help relieve the pain and swelling of lymphedema.

Our microsurgical procedures can help relieve the pain and swelling of #lymphedema. via @MedStarWHC

We offer two forms of lymphedema surgery: lymph node transfer and lymphovenous bypass. Both of these tend to be more helpful and effective for patients who are in the early stages of lymphedema, rather than patients who have had lymphedema for a long time.

Lymph node transfer

In lymph node transfer surgery, we take healthy lymph nodes from another part of the body and transplant them to the area of swelling in a patient with lymphedema. These healthy lymph nodes then can improve the drainage of lymph in the patient’s arm and reduce swelling.

We normally take healthy lymph nodes from a patient’s groin. Our microsurgical techniques mean we only need to make tiny incisions on the hand, as well as an incision on the groin that’s easily hidden by underwear or a bikini.

Patients who live in the Washington, D.C., area stay in the hospital about 23 hours after surgery and go home. If a patient comes in from outside the region, they stay in the hospital for about two days, stay in the area but not in the hospital for a week, and then go home for care from their regular doctor.

Lymphovenous bypass

In lymphovenous bypass surgery, we lower lymph buildup and pressure by connecting blocked lymph vessels to nearby veins. This lets lymph drain away from the swollen arm to reduce swelling.

This is an outpatient procedure, meaning patients can have the surgery and go home the same day. Lymphovenous bypass only requires tiny incisions and involves very little blood loss.

Achieving goals for treating lymphedema

Before I came to MedStar Health, I was chief of plastic surgery and associate dean at the University of Chicago, where I built a lymphedema surgery program from scratch. When I left, that program was the busiest in the country for the surgical treatment of lymphedema. I plan to do the same at MedStar Washington Hospital Center and MedStar Georgetown University Hospital.

Our main focus is on how we can help our patients achieve their goals. Curing lymphedema is, I think, at the top of the list for every patient with lymphedema, and these surgeries can do that. But even if we can’t cure it completely in some cases, we can dramatically improve patients’ quality of life and help them manage the condition better.

Treating patients for lymphedema is one of the most rewarding things I do as a surgeon. I love getting to help my patients reduce or even eliminate painful swelling and improve their mobility. And I love seeing the nearly immediate positive benefits these surgeries can have on my patients’ lives. I’m hopeful that we’ll be able to help more patients enjoy life without the pain and discomfort of lymphedema.