Woman’s Own Tissues Offer Natural Alternatives to Silicone Gel Breast Implants
A surgical procedure gaining attention across the country may provide a safer, more natural alternative to silicone gel breast implants.
The procedure involves taking excess skin and fat from the woman’s own abdomen, buttock or thigh to mold a new breast or breasts, said Roger Khouri, assistant professor in plastic and reconstructive surgery at Washington University’s School of Medicine.
“Using a patient’s own tissue is far superior to current artificial implant procedures,” Khouri said. “The tissue is not rejected, sensation returns to the breast, which never occurs with implants, and you avoid the potential complication of leakage and disfiguring scar formation.”
The procedure is being used primarily for women who have mastectomies and those who have had problems with breast implants, Khouri said.
But as the technique, known as the microvascular free flap, is perfected and more surgeons are trained, it someday could be an alternative to implants for women who want to enlarge their breasts for cosmetic reasons, Khouri said.
The development is important especially in light of the controversy over silicone gel implants, which critics say are harmful to women when the implants leak.
An advisory panel of the FDA recommended in February that silicone gel implants be permitted only for reconstructive surgery, not for cosmetic reasons. FDA Commissioner Dr. David Kessler is to make a final decision Monday.
“I’m convinced it’s going to be the way of the future,” Khouri said. “It’s just a matter of time and getting the system down.”
Anne Gorman, a spokeswoman for the American Society of Plastic and Reconstructive Surgeons in Arlington Heights, Ill., said the technique so far has been used only in a very limited number of breast reconstructions. But interest in the procedure is growing, she said.
“I think that as more women are looking for alternatives to implant surgery, it’s definitely something that’s going to be getting more attention,” she said.
Plastic surgeons more commonly are performing a similar type of reconstructive surgery using the women’s own tissue. The conventional flap technique involves using tissue from the women’s abdomen that is still attached to the abdominal muscle to form a breast.
Khouri’s technique involves completely detaching a section, or flap, of tissue, then reattaching it to the upper body and reconnecting the tiny blood vessels with the aid of a microscope.
“This way the tissue survives, and you can shape it, sculpt it, fold it and give it a new function,” he said.
With the conventional method, the woman loses the use of some or all of the main abdominal muscle, depending on whether one or two breasts are reconstructed, Khouri said. With the free flap, she doesn’t lose much muscle and gets the added benefit of a tummy tuck, a buttock lift or a thigh re-contouring, he said.
“The conventional flap is really within the reach of most plastic surgeons,” said Khouri, who directs the microvascular surgery service at Barnes Hospital. “It’s a smaller number of plastic surgeons who are comfortable doing the microvascular flap because that involves repairing the tiny blood vessels and that part is really the Achilles tendon of the whole thing, because those blood vessels are very, very small.”
William Shaw, professor and chief of the division of plastic surgery at UCLA, is considered a leader in the free flap technique. Women need to be aware that there is an alternative to breast implants, he said.
“It’s more work and all that but the long-term advantage is much greater,” he said. “It’s permanent and it’s natural.”
Shaw and Khouri said the technique often may be the best bet for women whose implants have failed.
Drawbacks of the free flap technique include cost and time, the doctors said. The procedure is more complicated, so it takes longer and costs more. In addition, the woman is left with a scar where the tissue is removed.
“At this stage, at least, it’s hard to justify it for pure cosmetic reasons,” Khouri said.
