Hybrid Breast Reconstruction
What is Hybrid Breast Reconstruction?
Hybrid Breast Reconstruction, sometimes referred to as “Composite Breast Reconstruction”, provides a solution for rebuilding the breasts with natural living fat combined in a single stage with supplemental breast implants. The Hybrid Breast Reconstruction technique gives added size and projection to the new breasts when a single donor site tissue transplant is not enough. In women with less body fat, adding a small breast implant beneath the living fat transfer can provide the surgical equivalent of a breast augmentation after mastectomy.
Hybrid Breast Reconstruction can restore shape and size beyond that of ordinary flap procedures. A DIEP, APEX FlapSM, or SGAP breast reconstruction can be combined with a gel or saline filled implant to support volume while providing the softness and natural look of living tissue breast reconstruction. The careful preservation of strength and muscle function, along with the characteristics of modern breast implants completes a “hybrid” combination that can bring outcomes that are not possible with either individual technique.
Other options for the thin woman who prefers a breast made up entirely of natural tissue without implants are the Body Lift Flap®, SGAP, & Stacked FlapSM breast reconstruction procedures.
The Center for Restorative Breast Surgery is a pioneering institute in the field of modern breast reconstruction and has led the way to improved outcomes for women seeking the best in reconstructive options for over 15 years.
When is it used?
Hybrid Breast Reconstruction is used to recreate a soft, natural breast made of living fat that is “boosted” with an implant to reach proper size and projection. It is used when the tummy and other donor site tissues are too thin for an ordinary flap procedure. For women who need a larger breast size than their fatty tissue donor sites can provide, this technique can give the best of both natural tissue softness and volume support from an underlying implant. It is used for women who understand the risks and benefits of breast implants as a part of their reconstructive plan.
The combination of more than one technique in this way produces a larger breast and allows the incision in the donor site to be designed in a cosmetically ideal location. In almost every case, the Hybrid Breast Reconstruction procedure can be done on the same day as mastectomy, this is known as “immediate reconstruction”. For women with a previous mastectomy, the Hybrid Breast Reconstruction may be performed after treatment. This is known as “delayed reconstruction.” Almost ALL women are candidates for immediate reconstruction, so speaking with your team prior to mastectomy about reconstruction is important.
The Hybrid Breast Reconstruction procedure gives thin women a new option to fully restore the breast after mastectomy by combining the best of both natural living tissue and breast implants.
What are the Benefits?
There are several benefits of the Hybrid Breast Reconstruction. The primary benefit comes from adding the softness of living fat to cover the look and feel of the implant. This makes Hybrid Breast Reconstruction superior to an “implant only” breast reconstruction for a number of reasons. After skin or nipple sparing mastectomy, the remaining skin is thin. This tends to produce palpable or visible wrinkling with implant only reconstructions. Additionally, if capsular contracture occurs (scarring around the implant) it is readily visible and the resultant firm texture is easily felt.
Adding a natural living fat layer over the implant reduces the size of the implant required. This allows the implant to be “camouflaged” by the overlying texture and volume of the soft fat layer. The thickened coverage over the implant also protects the thin skin left by mastectomy. The result is a more durable, trouble free solution than a generic implant reconstruction can provide. Taking less fat from the donor site and supplementing it with an implant also allows the donor incisions to be narrower and the feminine form to be enhanced as a nice compliment to the newly reconstructed breast.
Women who choose Hybrid Breast Reconstruction should understand the risks and potential maintenance requirements of modern breast implants. The FDA recommends screening for “silent rupture” of silicone implants using MRI beginning at 3 years post-implantation and then every 2 years thereafter. You should also continue to receive routine follow-up with your physician as recommended by your care team.
What are the Risks?
As with any surgery, the risks of surgery can be minimized by carefully following your pre-surgical instructions. The specific risks of adding a breast implant to your reconstructive plan can include “capsular contracture” which is the body’s response to a foreign material implanted beneath the skin. Although relatively rare, the result can be a distorted shape and in some cases chronic pain. The use of the smallest implants covered by living fat with “Hybrid” technique is thought to reduce this risk compared to an “implant only” breast reconstruction.
Additional risks include the possibility of implant rupture. Modern implants are more durable than those of the past but they can still fail and need replacement over time. The likelihood of this for an individual is unpredictable and varies patient to patient. Smaller implants tend to be more durable than larger ones. The “Hybrid” combination typically only requires a very small implant to supplement the volume of the DIEP, APEX FlapSM, or SGAP breast reconstruction procedures. If an implant does rupture, it is replaced surgically with a new one at a time convenient for the patient. Saline implants show volume loss in the breast if the fluid leaks out. The liquid content is salt water and is absorbed harmlessly by the body. Silicone implant leaks can be harder to detect and MRI screening for “silent rupture” is recommended by the FDA as noted above.
Implants have not been determined to interfere with cancer screening and have been judged to be otherwise safe when used as a part of modern breast reconstruction.
If you have other medical problems or items that increase your risk, we will work with you to educate you on proper preparation and arrange your clinical care to maximize your safety and proper recovery.
What to Expect
Pre-Surgery Office Visit
In most cases, you will be seen in our office 1-2 days prior to your surgery. At that time, we will go over the planned procedure, review consents, answer any questions you may have, and apply any surgical planning markings as may be required.
When you arrive at the hospital, you will be escorted to the preoperative holding area where you will change into a gown and be given foot coverings. The nurse or anesthesiologist will start an IV so that fluids and necessary medications may be given to you. Family members will be allowed to visit with you in the preoperative area once you are prepared for surgery.
After your surgery is complete, you will awaken in the recovery room under warm blankets with a dedicated nursing attendant at your side. You will be carefully monitored and kept comfortable. You will then be transferred to a private inpatient room that is prepared to allow you to rest and recover under the supervision of your attending physician and nurses. One adult caregiver may stay with you overnight during your hospitalization. A fold-out Murphy bed has been integrated into your room for their individualized comfort.
Your procedure will be performed in a state-of-the-art operating suite that is part of a fully accredited hospital that has been recognized by the American College of Surgeons for Excellence in care quality. Highly trained professionals using the most modern equipment and techniques will attend to you. In addition to your surgeons, the surgical team includes anesthesiologists, operating room technicians, nurses, and physician assistants.
What to Expect Post-Operation
You will experience some changes that are quite common after surgery and may include:
Some mild swelling and bruising is to be expected after surgery and will gradually subside after a few weeks.
Some soreness is normal after surgery, but we will provide medications to maximize your comfort and help speed up your recovery. Intermittent muscle spasms and feelings of tightness are normal and will subside as your swelling resolves.
Scar lines tend to improve in appearance for up to a year and are usually faded by 12-18 months.
Some numbness in the skin is normal after surgery. Occasionally the recovery of sensory nerves can result in tingling, itching, or mild electrical sensations that come and go. These sensations will resolve over time and are usually accompanied by some return of feeling in the skin.
You may resume your normal activities as recommended by your surgeon. In most cases, avoidance of strenuous activity is recommended for 4-6 weeks. As a general rule, most patients can drive between 2-3 weeks after surgery if you are no longer using pain medication and your doctor has cleared you. It is recommended to perform gentle stretches for the shoulders beginning in the early weeks after your procedure. Your clinic team can provide specific instruction for a post-mastectomy range of motion exercises as applicable. You should maintain the full range of motion within the early weeks post-operation. Patients are generally released to return to full activities and work schedule between 4-6 weeks after surgery. Your clinic team will provide any necessary documentation for your employer.
If you are traveling from out of state or internationally for care with us, your caregiver will need to be with you throughout your stay post-discharge and on the same flight home to assist you in the airport. Your caregiver’s education will be provided by our nursing staff during your time with us and our team is available to you and your assistant 24 hours/day should any questions arise after you are released from the hospital. Your arrangements for assistance after surgery should include an estimated seven to ten days of availability from your caregiver.
We Are Here For You
Be reassured that you are being attended to by some of the most highly skilled and dedicated healthcare providers in the world. Do your best to relax knowing that we are going to take excellent care of you from the moment you enter our facility. Do not hesitate to ask for any special needs you may have.