Gap (Gluteal Artery Perforator) Flap for Failed Implant

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Hi everyone,

I didn't think I'd be back here for a long time, but six years out after receiving a gummy implant (the cohesive gel implant), the reconstructed breast is failing due to capsular contracture. When I saw my PS this past week, the first thing he noticed was how tight and hard the implant had become over the last year. It's now much smaller and much higher than my other natural breast, which had a lift and small implant at the time of my exchange surgery from the expander to the gummy. The reconstructed side also hurts like a *itch, which he said was the large amount of scar tissue and tightness from the contracture.

The PS is now recommending a GAP Flap to replace what has become a hideous looking reconstruction (seriously, I'm not exaggerating, it looks horrendous after the contracture and due to an infection I was battling right after the initial mastectomy). At the initial time of my mx surgery, six years ago, I didn't have enough fat for a tissue transfer reconstruction, and given that I had not had radiation, the implant route seemed the best option. Fast forward six years and post-menopause, and apparently I still don't have the abdominal fat but do have some in my butt which will do the trick. My natural breast, even with the small implant, isn't large (about a full C with its augmentation), so I guess he doesn't need much skin and fat.

I'm torn whether or not to proceed and curious to see what others thought about this procedure. On the one hand, I've always hated this gummy, even more so now that it hurts so much. The PS said that one option could be to take this gummy out, clean out all the scar tissue, and place another one, although now that I've had capsular contracture, he gave me only a 60% chance of the new implant being successful, for how long, I don't know. Why the number 60%? Who knows, but that's what he said. Also, it's a pain to have to go in for MRIs, etc. to watch out for ruptures, and since I'm in my early 50s, even if I get a new implant and it works, it won't last forever, and I'll have to have surgery in the future at some point to replace it.

But this Gap Flap is major surgery! I was looking forward to a nice, relaxing summer, and now I've got this surgery on the horizon, and it looks to be a pretty painful surgery. Also, once the tissue transfer is done, don't I need to have a nipple made? And then there's the matter of one more scar on my body (the butt, and I've already got the long scar from a nipple reconstruction from my groin area, which didn't matter anyway, because the implant failed!!), all in the vain attempt to regain some semblance of a relatively normal looking breast again. Complicating the decision even further, I've had a number of call backs on my remaining right breast, and there's one area in particular they're watching more closely now. Would totally suck to lose that one too.

On the plus side, when the Gap Flap is done, it's done, no more worrying about implant failure, ruptures, etc. And I do like and trust my PS, but hate going back into the hospital for a major surgery that's just "aesthetic," even though what's on my chest now is hideous to look at.

I hate these decisions.....help! Any feedback? Thank you!!