One thing you can say about breast cancer survivors: they have fortitude. They don’t give up on life, and then after they have beaten cancer, they don’t give up on getting back their quality of life. To retake ownership of their own bodies, their sexuality, and their self-esteem, many women choose breast reconstruction after mastectomy. There were over 100,000 procedures performed in 2016 alone.

Breast reconstruction involves surgery to recreate a breast mound and (optionally) a new nipple. Because all women and all cases of cancer are unique, no two surgeries are the same. However, there are two main ways a breast mound can be reconstructed: using implants or using tissue from another part of the patient’s body (autologous reconstruction). Sometimes a combination of the two is also done.

  • Breast implants can be filled with silicone gel, saline, or a combination of the two.
  • Autologous reconstruction uses tissue usually taken from the patient’s thigh, back, buttocks or abdomen.

There is great debate over which of the above two methods is best. Autologous reconstruction may result in softer more natural looking breasts but a second surgical site is needed for harvesting the graft tissue. Implants may allow for larger breasts, but they may not look and feel as much like a woman’s natural breasts. The choice is personal and should be made with the help of a qualified plastic surgeon experienced with breast reconstruction.

Both options have been studied extensively, are safe, and result in high patient satisfaction scores and improved quality of life. Even so, a small percentage of women who have implant-based breast reconstruction later decide to have their implants removed and change to autologous reconstruction. This may be due to personal choice or complications.

Based on experience, many plastic surgeons will tell you that patients do well after this kind of second reconstruction. However, because it is not so common, there has been little research on how well these patients do statistically as a group. That is until now.

Researchers at Memorial Sloan Kettering Cancer Center collected and analyzed data on women treated at their center between 1997 and 2017. Their results were published this month (February, 2019) in the journal Plastic and Reconstructive Surgery.

The research team found just under 140 women who had undergone autologous reconstruction after what was considered a “failed implant-based reconstruction.” They defined the implant procedure as “failed” if the implant became scarred down and resulted in discomfort and a change in breast appearance.

On average, the women included in the study had the second reconstruction three and a half years after the first one. Analysis of the medical records and patient surveys showed a good success rate, few complications, and “significantly improved patient satisfaction and quality of life.”

This is good news for the few women who experience complications with breast implants following mastectomy. For them, an autologous reconstruction may be a very good option, and these women deserve all the options we can give them.


Dr. Charles Slack completed a plastic surgery fellowship, followed by an additional surgical fellowship in Cosmetic and Reconstructive Surgery of the Breast at Georgetown University.
If you have been diagnosed with breast cancer and are considering reconstruction, it is not too early to talk to an experienced plastic surgeon. Contact our office to schedule an appointment with Dr. Slack today.