Breast Reconstruction Without an Implant or a Flap

An Alternative to “Going Flat”

There has been increased interest over the last few years in flap free, implant free breast reconstructions.

For flap reconstruction, such as TRAM flap, DIEP flap and SIEA flap, surgery involves using an area of fat or muscle to do the reconstruction. These areas vary, from sacrificing the latissimus muscle that allows us to move heavy objects, or causing long scar on the abdomen or lower body. These surgeries are long, and carry the risk that the transferred tissue may die. Few patients choose flap breast reconstruction, as they often do not want to sacrifice a “donor site” or loose muscle strength.

In implant reconstruction, an implant is used, often following a tissue expander. Within the last few years, more women have been diagnosed with BIA-ALCL, a rare form of lymphoma caused by textured breast implants. Although rare, using implants associated with cancer is frightening for patients that are striving to conquer breast cancer. Additionally, more patients are reporting breast implant illness, associated with silicone leakage and with biofilms located on the surface of implants. Breast implant illness is a multi-systemic disease associated with a wide range of symptoms, but free silicone and biofilms on implants are real issues that do appear to cause real symptoms and may need treatment. Again, for patients fighting breast cancer or high risk of breast cancer, it may be a big negative to be dependent on implants long term.

In the midst of all these problems, it’s not surprising that the New York Times and BreastCancer.org have promoted going flat as a good alternative to flap breast reconstruction and implant reconstruction. Many women are willing to avoid the above complications with flaps and implants, but in our experience, women do not want concave or deformed breasts. So our experts here at Bedford Breast cancer center in Beverely Hills have developed something better.

Starting with the Goldilocks mastectomy technique, we use any extra skin present during the mastectomy to create a breast mound. This has now metamorphosed into a true nipple sparing breast reconstruction. Using the extra fat that is usually thrown away during the mastectomy, the breast is created, although it is a complete nipple sparing mastectomy with no breast tissue remaining. The techniques vary according to patient, as some patients have larger, hanging breasts; other may have more “bra-strap” fat; and others, a neater breast without much skin or fat that is extra. In all types of patients, we create a breast rather than excise all the skin and “go flat”, produce and implant-free, flap-free, breast-free, aesthetic result, see a 70 year old patient’s results, below.

Heather Richardson MD, FACS
Breast Cancer Surgeon