Breast Reconstruction: Flap vs. Implant

Woman deciding on breast reconstruction flap vs. implant.

Whether you have had a mastectomy after a cancer diagnosis, or you are considering a prophylactic mastectomy because of one or more significant risk factors for developing breast cancer, one of the many decisions you will have to make is what kind of reconstruction is best for you. Most often, breast reconstruction is done immediately following mastectomy at the same surgical procedure, but occasionally, delayed reconstruction will be considered in women who have had a mastectomy in the past where immediate reconstruction was not offered, or immediate reconstruction is delayed for medical reasons.

Whatever your timing, you have two main options for breast reconstruction: tissue-based reconstruction flap vs. implant reconstruction.

You can review several options and different techniques with your plastic surgeon for both choices. There is no “right” choice between the various options – but there will be one that is right for you, your anatomy, your medical history, and your outcome preferences.

Breast Reconstruction: Flap vs. Implant

There are two main methods of breast reconstruction: flap vs. implant. Each entails several techniques, the most common of which are outlined in the table below.

Breast Reconstruction Techniques

Autologous Flap

An image showing where flap reconstruction will be located.

Implant

 
 

An image showing breast reconstruction using implants.

For a flap reconstruction surgery, skin, tissue, and sometimes muscle are taken from one area of the patient’s body and transferred to the chest to create the breast mound. The plastic surgeon uses microsurgical techniques to reconnect the blood vessels to ensure proper blood flow to the transplanted tissue. There are many different techniques for flap reconstructions.During implant reconstruction, implants are placed within the mastectomy site, most often above the chest wall muscles under the skin, but occasionally partially below the muscle, to recreate the breast mound. This procedure has multiple variations, from the type of implant to how the implant is held in place and may require staged tissue expansion.

Flap Surgeries:

  • DIEP Deep Inferior Epigastric Perforator – skin, fat, and deep inferior epigastric blood vessels, but not muscle, are taken from the lower abdominal area.
  • SIEA Superficial Inferior Epigastric Artery – skin, fat, and superficial inferior epigastric blood vessels, but not muscle, are taken from the lower abdominal area.
  • TRAM Transverse Rectus Abdominis Myocutaneous – fat, skin, blood vessels, and rectus abdominus muscle are taken from the lower abdominal area, typically below the belly button. Tissue transfer is done without microsurgery.
  • Latissimus Latissimus dorsi muscle and overlying tissue from the back.
    • This technique is often used when there is insufficient tissue in the abdominal area for other types of autologous flap reconstructions.

Implant Surgeries:

  • Saline Silicone shell filled with sterile saline (saltwater), uncommonly used because of a less natural feel and tendency for visible rippling.
  • Silicone Gel Silicone shell filled with a silicone gel.
  • Tissue Expanders  Empty silicone implant shells that are filled with saline solution over designated intervals to expand or maintain the overlying skin and make room for the final implants.
  • Prepectoral The implant is placed on top of the pectoralis muscle of the chest and held in place with an acellular dermal matrix or biologic mesh.
  • Subpectoral The breast implant is placed partially under the pectoralis muscle and held in position with an acellular dermal matrix.
  • Autologous Fat Grafting An adjunct to breast implant surgeries, where excess fat from one part of the body is transplanted to the upper pole of the breast implant for a better peripheral contour.
ProsConsProsCons
  • Flap surgeries often provide more natural looking and feeling breast reconstruction
  • No need for artificial materials to be implanted
  • Potential cosmetic improvements in the abdominal area
  • DIEP and SIEA do not interfere with muscle function
  • Long-lasting Results
  • Transferred tissue acts like natural tissue in the chest region to recreate a permanent part of the body
  • Improved contouring and breast symmetry
  • Complex microsurgical technique
  • TRAM flaps can lead to muscle weakness in the area where the tissue was taken
  • Longer recovery time
  • Longer hospital stay
  • Scarring on donor site
  • Latissimus dorsi flap may not provide enough tissue
  • Less complex surgery than flap reconstructions
  • If a saline implant ruptures or leaks saline is harmlessly absorbed by the body
  • Silicone gel closely mimics the feel of natural breast tissue
  • Silicone gel implants are known for providing a more natural look and feel
  • Less pain and discomfort during recovery
  • Faster recovery time
  • Implants close to the surface might be noticeable
  • Possible rippling (where the skin or implant surface wrinkles visibly)
  • Need for lifetime implant surveillance and possible implant replacement over decades
  • Possible implant displacement over time
  • If silicone gel implant ruptures, it is a silent rupture since the gel does not migrate or get absorbed.  MRI or ultrasound scans are needed for implant surveillance
  • Potential for dynamic deformity for subpectoral implants
  • Risk of capsular contracture

Shared Decision-Making With Your Plastic Surgeon

Your breast reconstruction journey will be unique and should be tailored to your needs and goals. To get the best outcomes from your reconstruction, you should feel comfortable and confident discussing all your options with your plastic surgeon. That includes not only the category of breast reconstruction: natural tissue or flap vs. implant, but also the method of flap or implant reconstruction, including implant choice, placement, and all the other considerations along the way.

All surgeries have specific pros and cons, risks and benefits, but clear and open communication with your plastic surgeon will help you decide which route to take. There is no correct choice in this process, but there will be a choice among all the options that is correct for you, and your plastic surgeon can help you determine that answer.

See Why Harris Plastic Surgery Is The Right Choice for You

Choosing a plastic surgeon for your breast reconstruction is about more than just finding the most qualified physician. You should choose a plastic surgeon with a long history of excellent surgical outcomes who will help empower you to make the choices that fit your life and goals. You also need a support staff who can walk you through all aspects of the process, including your most specific insurance reimbursement questions.

Dr. Harris and Joanne Parrinello have worked together through countless successful operations with seamless patient care management. Dr. Harris has extensive training and experience in all breast reconstruction techniques, including:

  • Direct-to-Implant
  • Acellular Dermal Matrices
  • Prepectoral Implants
  • Microsurgical Reconstruction
  • Oncoplastic Surgery
  • Autologous Fat Grafting
  • Autologous Flap Reconstruction (DIEP, SIEA, TRAM, Latissimus)
  • Plastic surgeon-first consultation in BRCA patients or patients with other genetic predisposition to breast cancer considering prophylactic mastectomy

Dr. Harris is also active on the Medical Advisory Board of the West Islip Breast Cancer Coalition.

Joanne has nearly two decades of experience in helping patients navigate the world of plastic surgery and insurance coordination. She is well-known for providing patients with a low-stress experience as the point of contact for their surgical scheduling and helping patients get the most out of their insurance coverage.

Choose Harris Plastic Surgery for your Breast Reconstruction

At Harris Plastic Surgery, we believe every patient who walks through our door is a unique combination of all her life experiences, knowledge, and goals. You are more than a procedure to us, and we are here to guide you through every step of the breast reconstruction: flap vs. implant decision-making process.

Bringing Patient Advocacy to Breast Reduction and Reconstruction

Contact Harris Plastic Surgery if you are ready to start your breast reconstruction or would like more information about a personalized breast reconstruction plan.

Stephen U. Harris, MD FACS

Dr. Stephen U. Harris is a board-certified cosmetic surgeon and recognized expert in breast reduction and reconstruction surgeries, having performed thousands in his career. When it comes to patient care, his philosophy is that every surgery should improve his patient’s overall quality of life, not just their appearance. Dr. Harris stays up-to-date on all the latest advancements in breast augmentation, reconstruction, and reduction and is a recognized innovator in the field. In fact, he was the first surgeon at Good Samaritan Hospital to offer primary prepectoral implant breast reconstruction, as well as secondary prepectoral revision surgery.

Dr. Harris also serves as Chief of Plastic Surgery at Good Samaritan Hospital in West Islip, New York and is an active staff surgeon (and former Chief of Plastic Surgery) at South Shore University Hospital in Bay Shore, New York.

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