Breast reconstruction is a long-term process that can involve revisions, changes, and new decisions as the body evolves. The good news is that as your body, lifestyle, and mindset shift over time, revision procedures can help address those changes. Some implant-based breast reconstruction patients later want or need to switch to a natural tissue breast reconstruction. This is called implant to natural tissue—or autologous—conversion. But why would someone make that change? What should they and their team consider? What are the risks and benefits?
We asked a plastic surgeon and a patient who underwent an implant to natural tissue conversion procedure to get to the bottom of this! Read on to This blog focuses on autologous breast reconstruction conversion—from implant-based reconstruction to autologous (your own tissue) reconstruction. It features a Q&A with Dr. Dickey, followed by a patient’s perspective. Read on for insight on what might make a patient change their reconstruction type, what recovery looks like, and much more, from both provider and patient perspectives!
Provider Perspective
About the Surgeon
Ryan Dickey, MD, is a board-certified plastic surgeon and Assistant Professor of Plastic Surgery at MD Anderson Cancer Center. He earned his medical degree from Baylor College of Medicine and completed plastic surgery training at UT Southwestern Medical Center, where he received numerous awards in research and teaching. He gained additional expertise with fellowship training in microvascular reconstructive surgery at MD Anderson. Dr. Dickey offers a broad portfolio of breast reconstruction options for patients to select from, including autologous and implant-based reconstruction, as well as novel approaches in nipple sparing techniques and breast neurotization. He currently sits on BreastReconstruction.org’s Medical Advisory Committee.
Q: What does “autologous breast reconstruction conversion” mean?
RD: “Autologous Conversion” means replacing an implant reconstruction with natural tissue reconstruction. After mastectomy, a patient may select either implant-based reconstruction or natural tissue (autologous) reconstruction. Some patients who initially select implant-based reconstruction may choose to switch their reconstruction to a natural tissue (autologous) option. In this surgery, we typically remove the implant and associated capsule and perform reconstruction using autologous tissue.
Q: Why might a patient choose to convert from implant-based reconstruction to autologous reconstruction?
RD: There are several reasons why a patient may be unsatisfied with implant-based reconstruction after mastectomy. Common reasons include breast asymmetry, implant rippling, capsular contracture, implant rupture, or issues related to prior radiation. Some patients may not like the feeling of an implant in their body, describing things such as heaviness, awareness of the implant pressing against their body, or temperature changes (coolness) in colder climates. Others may have undergone multiple implant correction surgeries and are seeking a more definitive solution. Some patients also attribute a variety of symptoms to their implants and prefer to have them removed.
Q: Who is a good candidate for autologous reconstruction after having implants? Who is not a good candidate?
RD: An ideal candidate is a patient who is not satisfied with their implant-based reconstruction and has adequate available donor site tissue available for autologous reconstruction.
Q: What types of autologous reconstruction options are available for patients converting from implants? How do you make that decision?
RD: There are many different types of tissue options for autologous conversion, with pros and cons for each flap type. At MD Anderson, we prefer perforator flap reconstruction and tend to offer abdominal-based free tissue transfer in most patients, with secondary options from the love handle (lumbar) region or inner thighs if the abdominal site is not ideal. Prior surgeries, such as abdominoplasty, autoimmune diseases, previous attempted free flaps and other patient factors are considered, as well as the specific donor features of the patient and perforator (blood vessel) anatomy.
Q: How does prior radiation or multiple implant surgeries affect the conversion process?
RD: Many patients seeking autologous conversion have had multiple implant surgeries or prior radiation. Radiation is a common indication for autologous reconstruction at our institution, and though this can make the reconstruction more technically challenging, it is a routine procedure.
Q: What is recovery like?
RD: Autologous conversion, like any autologous reconstruction, is a more complex surgery with a longer recovery compared to implant-based reconstruction. However, most patients are discharged by the second or third day after their surgery and are comfortably walking and performing light activity at home. Patients have some weight lifting restrictions post-op. They can expect full activity by 6-8 weeks after surgery.
Q: What risks or complications should patients understand when considering conversion?
RD: We counsel patients who are considering autologous conversion surgery on a few risks. The first is microsurgical risk (blood vessel connection between the body and the flap), which includes a small risk of blood clot or kinking. This typically occurs within the first 24-48 hours after surgery and can be addressed in the hospital. We cite a 1% flap loss rate at our institution. The other risk is donor site morbidity, and includes things such as fluid collection or wound healing delay of the incision. For specific sites such as the abdomen (DIEP flap), there is a small risk of abdominal bulge (<5%) or hernia (<1%).
Patient Perspective
Q: What made you start thinking about converting from implants to autonomous reconstruction?
A: My cancer and then implant saga began in January of 2015, two months after losing my husband to pulmonary fibrosis. Implants were the best option at that time and through the years I’ve had other implants. This time when my implant malfunctioned in 2025, my options were remove, replace or autologous reconstruction. The implants were never truly comfortable to me, because they were cold, hard and heavy. Knowing that this would be an alternative whereby I would not need further implant replacement surgery, my choice was autologous reconstruction.
Q: A What concerns or fears did you have before deciding to go with conversion surgery?
A: Knowing the whole unvarnished truth or ‘cold hard facts’ about the surgical procedure, the stages of recovery and the time frame involved were equally as relevant as wondering if I should attempt the surgery at 75.
Q: How did you prepare emotionally and physically for the decision to convert?
A: Moving past the obstacle of surgery and recovery to envisioning the end result was a first step. Determining how my counterpart felt about my surgery and helping me through the whole process was a major step. Additionally, deciding on ways to reward & pamper myself in the recovery process by getting my hair fixed at the salon, along with manicures and pedicures helped.
Q: What made the final decision to move forward with the conversion surgery?
A: The surgery had two perks: the mommy makeover aspect was one. The second was that autologous reconstruction would mean my own natural tissue and with warmth and that it would respond to weight gain or loss normally.
Q: How was the recovery for you in comparison to the implant reconstruction?
A: The autologous reconstruction is a bigger surgery, but the results are, as well.
Q: What advice would you give to a patient thinking about doing this?
A: After going through the whole process, ten months out, I’m satisfied with my ‘new breast’. No more implant replacement surgeries.
