There is no right and no wrong answer here, but you will want to weigh the pros and cons of each approach and decide what will be best for you.
In general, you should know that radiation treatment complicate breast reconstruction, particularly breast implant reconstruction. Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Natural-tissue reconstruction has the benefit of bringing non-radiated, healthy, well-vascularized tissue to the mastectomy site, and this can actually aid in the healing process.
Because of the potential complications associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation (this does not necessarily mean it is best for you).That said, in my practice I recommend natural tissue reconstruction for women who have had breast radiation as it gives you the highest chance of sucessful reconstruction. I favor perforator flaps such as the DIEP flap because such procedures not only avoid the use of an implant, but they also allow you to preserve your muscles.
In addition to giving you excellent cosmetic results without compromising important functional muscles, perforator-flap breast reconstruction offers several unique advantages:
* A more natural look and feel to reconstructed breasts than can typically be obtained with implants
* Less postoperative pain than is typically associated with reconstruction using flaps that include muscle
* Reconstructed breasts that will grow and shrink naturally as one’s weight changes, thereby keeping your reconstructed breast in proportion to your body
* Possible connection of sensory nerves in a perforator flap to nerves at the mastectomy site to help restore sensation to the reconstructed breast
* More rapid return to work and other activities than typically occurs following reconstruction with flaps that include muscle
* A significantly lower rate of unplanned reoperation (only 5%), as compared to the approximately 50% rate reported for implants 7 years after reconstruction
* Ability to reconstruct a breast after failure of an implant or other natural-tissue reconstruction, even after radiation
As you can tell, I would favor autologous tissue reconstruction with a perforator flap given your history., however, I suggest that you consult with board certified plastic surgeons and determine which method best suits you.