Breast Reconstruction With Implants When You Have EDS

A patient with Ehlers-Danlos syndrome (EDS) asked whether implant-based breast reconstruction is even possible for her.

Yes, absolutely. I've done mastectomy reconstructions on many patients with Ehlers-Danlos. We just make some minor adjustments to get you the best possible result. Here's what changes.

The commenter was exactly right about the central issue: with EDS, it's very common to have trouble with your tissue supporting the implant.

That's the whole challenge in one sentence. Implant reconstruction depends on the surrounding soft tissue to hold the implant where you put it, and EDS tissue is inherently more lax and less able to do that job. So the adjustments I make are all aimed at adding support the tissue can't supply on its own.

Most of us routinely use surgical scaffolding to help support the implant in reconstruction. But for EDS patients specifically, my preference shifts:

And I get more specific than that. I want meshes that leave behind a little firmer scar tissue as they dissolve, rather than ones that simply go away altogether.

The reasoning is straightforward: when your own tissue can't provide adequate support, you want the scaffold to leave something behind that does. A product that fully disappears returns you to relying on the tissue that was the problem in the first place. (This is exactly the distinction I draw between the dissolvable scaffolds I prefer and the ones I don't, and why scaffold choice changes how much things settle.)

Here's something I've learned specifically from my EDS patients:

They don't tolerate implant upsizes very well.

So if you want a larger implant than what you're starting with, it's often better to do that in stages rather than all at once at the time of the mastectomy, which is how I'd normally approach it.

Asking lax tissue to accommodate a significant volume jump in a single step tends not to go well. Building up gradually gives the tissue time to adapt to each increment.

Two honest expectation-setters.

Widened, atrophic scars are more common in my EDS patients. That's a known feature of how EDS tissue heals, and it's worth planning your scar care accordingly from the start rather than reacting to it later.

And overall: all of these issues are manageable, but together they mean a potentially higher risk of revision. That isn't a reason to avoid reconstruction. It's a reason to go in knowing it, so a second stage feels like part of the plan rather than a failure.

• Yes, you can absolutely have implant-based reconstruction with EDS. I've done many.
• The core issue is that EDS tissue struggles to support an implant, so every adjustment adds support.
• I prefer mesh over dermal matrix, specifically meshes that leave firmer scar tissue behind as they dissolve rather than disappearing entirely.
• Stage your upsizes instead of doing a large jump at the time of mastectomy.
• Expect widened atrophic scars more often, and a higher revision risk overall.

None of this rules you out. It just means your surgeon should be adjusting the plan for your tissue, not running the standard playbook. If you have EDS and you're heading toward reconstruction, ask your surgeon directly what they change for connective tissue disorders. The answer will tell you a lot.