When Given All Choices for Breast Reconstruction, More Women Are Opting Against Implants

By PRMA Plastic Surgery | Center for Advanced Breast Reconstruction
Monday, November 20, 2017

Implants are the most common method of breast reconstruction performed today, but they are not considered the gold standard. Because of the extra training needed and the complexity of more advanced procedures like the DIEP flap, few centers in the U.S. truly offer the full spectrum of breast reconstruction procedures. Unfortunately, reports today show seven out of 10 women are never told about all their breast reconstruction options, with many believing implants are the only choice.

Although breast implants may be the best option for some, the proportion of women who disagree appears to be on the rise. Some women prefer to avoid implants in general, while others opt to remove them because of complications. In either case, more women are deciding between going flat, or having “natural” reconstruction using their own tissue if that is an option for them.

Implant alternative procedures, like the DIEP flap, provide women with warm, soft, natural breasts after a mastectomy.

The DIEP flap is today’s gold standard in breast reconstruction. The procedure uses a patient’s lower tummy skin and fat, which are transplanted to the chest to reconstruct a breast using microsurgery. Unlike the more commonly recognized TRAM surgery, the DIEP spares all the patient’s abdominal muscles. This significantly reduces the risk of abdominal complications (like bulging or a hernia) and overall recovery time. Women also enjoy the added benefit of a flatter abdomen with results similar to a tummy tuck.

Lower tummy fat mimics breast tissue closely in terms of consistency and is the ideal tissue to create a “natural” breast. Nerves damaged during a mastectomy — leaving the patient’s chest numb — can also be repaired during this procedure. Sensory nerves are transferred with the DIEP flap to the chest and reconnected to nerves cut by the mastectomy. This provides a better chance of regaining feeling to the new breast in a shorter amount of time. Unfortunately, sensory nerve reconstruction is not possible with tissue expander or implant breast reconstruction.

DIEP flap breast reconstruction can be performed at the same time as the mastectomy or any time later. It can also be performed for women who are unhappy with their existing implant reconstruction(s).

“I initially went with implants because that seemed to be the ‘standard’ treatment. Other options were discussed, but not in a detailed and thorough way,” shares breast cancer survivor Kim. “I was unhappy with my implants for many reasons. They were unnatural in the way they looked and felt. I was never told they would be cold to the touch. I also had discomfort under my arm and across my upper back due to the ‘pulling’ of the muscle.

“I heard...I mean REALLY HEARD about DIEP flap from PRMA on Facebook,” she continues. “I spent months researching both DIEP and PRMA, looking at before and after photos, and reading blogs about other people’s experiences. I wasn’t sure I was a good candidate, but I emailed PRMA with all my questions. After much thought, I decided it was time to schedule an appointment with the surgeons at PRMA!”

Educating patients about all their breast reconstruction options is at the heart of PRMA.

“We are strong believers in shared decision making,” states Minas Chrysopoulo, MD, board-certified plastic surgeon, breast reconstruction surgeon and microsurgeon. “The women who walk through our doors deserve to be fully informed of all their choices and the pros and cons of each. It is our responsibility to provide them with evidence-based information to help them reach a decision that best suits their personal needs.”

Despite women’s desires to avoid implants, many are still fearful of more pain and a prolonged recovery with more complex procedures like the DIEP flap. Many presume breast reconstruction with implants is less painful compared to DIEP flap surgery. Although every individual’s journey is different, the majority of patients undergoing implant-based reconstruction report more pain and use more narcotics. This is largely because most implant reconstructions involve placing tissue expanders under the chest muscle.

In reality, patients can undergo DIEP flap surgery with less discomfort than traditional expanders. Thanks to PRMA’s new Enhanced Recovery after Surgery (ERAS) protocol, our patients experience less pain and a much faster recovery. The ERAS protocol ensures patients remain very comfortable and rarely need narcotics to control pain levels after DIEP flap surgery. Our DIEP flap patients are able to get up and moving quicker after surgery and are ready to go home after two or three nights.

“I am so glad I made the choice to have the DIEP flap procedure!” Kim shares. “I am seven months from the initial surgery and I don’t regret my decision. My breasts now feel so natural and warm. I never realized how important that was to me. I would do it over in a heartbeat. I just wish I had found PRMA sooner!”

PRMA Plastic Surgery in San Antonio, Texas, specializes in state-of-the-art breast reconstruction. Procedures offered include the DIEP flap, SIEA flap, GAP flap, TUG flap, fat grafting, vascularized lymph node transfer and nipple-sparing mastectomy. PRMA is In-Network for most U.S. insurance plans and routinely welcomes patients from across and outside the U.S.

To learn more about PRMA, call 800-692-5565 or visit PRMA-enhance.com.