Better Symmetry? Lat Flap with Implant or Tissue Expander and Implant?

I am 35, having a unilateral mastectomy, no chemo, no radiation. I've received two different opinions from board certified plastic surgeons about reconstruction - one said tissue expander (delayed) will achieve symmetry and no Lat flap technique is necessary, the other indicated a Lat Flap with implant(immediate) will achieve symmetry best and the delayed tissue expander option will result in a flat breast. Is this true - how do I choose?

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age 35-44 mastectomy asymmetry comparison expander latissimus flap tissue

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13 Doctor Answers | Asked by jmsllp in Boston, MA

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Options for breast reconstruction

Without more details it would be difficult to give you specific advice, but you might consider these principles in making this decision: 1. Delayed reconstruction is associated with a lower complication rate. 2. Placement of a tissue expander is a simpler operation, with no donor site involved. 3. The latissimus dorsi flap is a more complex operation, with a longer recovery, but has the advantage of a potentially better result. 4. Delayed reconstruction will sacrifice... more

Latissimus dorsi flap versus tissue expander.

There is no question that immediate reconstruction with a Lat flap and implant will give you the best symmetry and the most natural looking breast. The trade off is that it is a bigger operation and a scar on your back. A delayed tissue expander will never give you as natural a result but it is less invasive surgery with less down time. No procedure is perfect. You have to decide what issue is most important to you in order to make your decision. Best of Luck.... more

Best Unilateral Breast Reconstruction for Symmetry

In your question you suggested a choice between skin expander and latissimus dorsi breast reconstruction for achieving symmetry after a unilateral breast reconstruction. Accepting the limitation to these two choices, I generally would choose a latissimus flap, particularly if your breasts were not to large and the latissimus along could provide sufficient volume to match the non-mastectomy side. My reason for this is that the latissimus dorsi flap provide a soft warm natural breast... more

"Direct to implant reconstruction"

There is no reason in your situation to use a muscle ! You could have a direct to implant reconstruction and have a wonderful breast without expanders or the need to use your LD muscle !!

Choice of reconstruction

If you are going with a tissue expander implant reconstruction, a latissimus flap to me is a life preserver for a secondary procedure if the primary reconstruction fails secondary to radiation. Since you are not having RT I would do the expander and implant.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Timing and choice of reconstruction

If you do not need chemotherapy or radiation therapy, you should consider immediate reconstruction. Immediate reconstruction is done at the time of mastectomy and can give you the best cosmetic outcome. In terms of LD flap/implant vs. tissue expander, if you are undergoing simple, skin sparing mastectomy, you should be okay with tissue expander placement as your first stage. If you are needing more radical mastectomy where you need more skin coverage, then you may need... more

LD/Implant Reconstruction

It is hard to decide when you have received two diverging opinions. Both surgeons should have a good rationale for their recommendations. However, from the limited information provided, I don't see any reason that a delayed or secondary reconstruction would be necessary. In most cases, reasonably good symmetry can be achieved with either tissue expansion/implant reconstruction, or LD/Implant reconstruction. The LD will provide additional soft tissue in the form of muscle and skin... more

Breast reconstruction

Frequently this issue requires addressing the opposite "normal" breast as well. Depending on the size and shape, various options may be better suited. Your best symmetry will likely require a reduction or lift on the opposite side. IF you have a small breast on the normal side an expander may be a reasonable option with a skin sparing mastectomy. However, if you have a larger, ptotic breast, a latissimus flap may be a better option to achieve the look you seek.

Otto Joseph Placik, MD

33 reviews

Chicago Plastic Surgeon

Breast reconstruction

There are options in breast reconstruction 1: tissue expander, and implants 2: Latismus Dorsi flap with or without implant, depending on size and type of mastectomy 3: TRAM flap 4: Free flap All can achieve symmetry, but not perfection. There are pros and cons for each method, and different risks. See multiple plastic surgeons and discuss all options available to you. Between the both of you, you will reach to a decision that... more

Breast reconstruction after mastectomy

Symmetry is dependent on more than just the technique. Simply put, to achieve symmetry, do similar things to each side. The questions are: what does your opposite good breast look like and what, if anything, are you willing or wanting to do to the good breast. On the mastectomy side, your choices are either implant or not implant (autologous) reconstruction. If have small breasts, and not wanting to augment the good side, an autologous reconstruction with a TRAM flap or extended... more