Switching From Implants to Natural Tissue (Flap) Reconstruction

Women who have implant-based breast reconstruction sometimes want to change to natural tissue. This surgery is called autologous conversion.

During the procedure, the surgeon replaces your implants with your own tissue. The tissue is usually taken from the lower abdomen, the inner thigh, or the flank (or love handles). The transferred tissue is called a “flap.”

Autologous conversion is a complex surgery. It starts with the surgeon removing the implants and putting the donor site tissue in place. Using a microscope, the surgeon then connects tiny blood vessels in the donor tissue to blood vessels in the chest area. The procedure is performed under general anesthesia and typically lasts six to eight hours.

If you undergo this surgery, you will not need implant screening or future implant exchanges. The reconstructed breast also tends to look and feel more natural over time. It will soften, move and age with the rest of your body and results can last a lifetime.

Why patients switch to natural tissue reconstruction

Women change from implants to natural tissue for many reasons.

Some patients are unhappy with how their implants look or feel. Many simply want a permanent reconstruction that does not require future screening or surgeries to replace implants.

Other patients have complications from their implants, such as:

• capsular contracture, the hardening of scar tissue around the implant
• rippling, or wrinkles/folds in the implant that can be seen through the skin
• rupture
• pain.

Who is a candidate for autologous conversion?

Most women with prior implant-based breast reconstruction are candidates for autologous conversion. Before recommending surgery, doctors will consider several factors, including:

• your general health
• your body shape
• the available donor tissue
• medical imaging
• your medical history, including prior surgeries and radiation treatment.

Autologous conversion outcomes

Long-term outcomes for autologous conversion patients are excellent. Reconstructions made from your own tissue typically last a lifetime. Unlike implant-based reconstruction, they do not require routine implant maintenance.

Recovery after switching to natural tissue

Recovery from autologous conversion takes longer than recovery from implant surgery, but most patients return to their normal lives within a few months.

Hospital stay: Most patients stay in the hospital for three to four nights after surgery. The medical team monitors blood flow in the flap closely during this time.

Activity: Patients are usually back to light daily activities within two to three weeks. Heavy lifting and strenuous exercise are restricted for six to eight weeks.

Look and feel: The reconstructed breast is typically softer and more natural appearing than an implant reconstruction.

Donor site care: Most patients perform scar care for the donor site (the abdomen, thigh or love handle) once it has healed. The donor site scar is permanent but fades over time.

Follow-up: Patients return for follow-up appointments throughout the first year. Some choose a small revision surgery later to refine shape or symmetry.

Risks of autologous conversion surgery

Like any major surgery, autologous conversion has risks. A plastic surgeon will review each of these in detail before surgery.

• Flap complications: The transferred tissue depends on blood flow through reconnected vessels. In rare cases, the flap can lose its blood supply and require additional surgery.
• Donor site complications: Bulging, weakness or hernia can occur at the donor site, especially the abdomen.
• Infection: Any surgical site can develop an infection that may require antibiotics or additional surgery.
• Fat necrosis: Small areas of the transferred tissue can form firm lumps that sometimes need to be removed.
• Asymmetry: The reconstructed breast may not perfectly match the other breast. Many patients choose a small revision surgery later.
• Anesthesia risks: Autologous conversion is a long operation under general anesthesia, which carries its own risks.

Why choose UT MD Anderson for your switch to natural tissue reconstruction?

UT MD Anderson is a world leader in breast reconstruction. Our plastic surgeons perform more autologous breast reconstructions each year than nearly any other center in the country. Many of the techniques used in autologous conversion today were developed and refined here.

At UT MD Anderson, your team includes microsurgeons, breast surgeons, oncologists, nurses and rehabilitation specialists. They work together to plan each patient’s care. This team approach is especially important for women considering conversion, because each case requires careful planning around prior surgeries, scars and any history of cancer treatment.

The Center for Reconstructive Surgery at UT MD Anderson is one of the largest programs of its kind. Our plastic surgeons perform hundreds of autologous conversions each year, giving them extensive experience switching reconstruction from implants to natural tissue.

Patients at UT MD Anderson also have access to comprehensive support services. These include pain management, physical therapy, counseling and survivorship care. From the first consultation through long-term follow-up, our team supports each patient through every step of recovery.