Implant vs Flap Breast Reconstruction. Having a Hard Time Deciding; Any Advice?

I am having a bi-lateral mastectomy soon and researching reconstruction. I've seen 2 doctors: one who performs direct 1-step implants w/alloderm; the other performs flap operations and recommends a combo hip flap w/implant. I'd like to increase in size by about a cup (from small b to small c). I am 5'6" and approx 125 lbs. I'm having a hard time deciding, as the implants look good at first, but seem to have potential future issues. The flap looks decent but recovery is harsh/lengthy. Any advice?

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6 Doctor Answers | Asked by Charlotterox

Doctor Answers (6)
Community Comments (1)

Breast reconstruction options

There are two major categories for breast reconstruction: 1) Implant-based reconstruction, and 2) autologous (own tissue) reconstruction. You decision should be based on 1)your social need (can you take 3-6 weeks off from your work for autologous reconstruction), 2)cancer staging (need for radiation), 3) your preference. Some people like the "look of implants" whereas others want to look more natural. With implants, you can tailor your reconstruction to go bigger if you... more

Options for Breast Reconstruction

We base reconstruction options on your body habitus and cancer type. As plastic surgeons, we do not want the reconstructive process to interfere with your necessary cancer treatment. If your plastic surgeon is offering an implant with hip flap, it sounds as though you may not have enough tissue for a primary autologous reconstruction. The advantage of implants is that you can always go back down the road to replace them with tissue. ... more

Breast implants and flap reconstruction options each have their specific indications, risks & benefits

Women who require a mastectomy for breast cancer generally have two options for breast reconstruction: 1. Implant-based reconstruction - single-stage technique or traditional submuscular two-stage expander/implant reconstruction 2. "Flap" reconstruction - which uses the body's own tissue, and can be "pedicled" (based on a muscle) or "free" (based on blood vessels that use Microsurgery to move the tissue) Which option is the best? The best reconstructive option for the... more

Breast reconstruction options

There are several things to consider when selecting a reconstructive technique including your cancer treatment plan (will you require radiation?), your anatomy, your overall health status and your goals/preferences. There are two major categories for post mastectomy breast reconstruction: 1) implant based and 2) autologous (using your own tissue such as a DIEP flap). Each modality has its own pro's and con's. My preference for reconstruction is using a woman's own tissue... more

Breast reconstruction

In most cases I prefer autologous tissue reconstruction( your own tissue). I am not sure why you were offered a combination of autologous tissue with an implant? Maybe you do not have enough tissue in your hip region. Without an exam it is hard to say what would be right for you. Good luck.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reconstruction

There are too many variables to give you a recommendation regarding flap versus implants. Part of it may be if there is any possibility that radiation will be necessary. While it is advantageous to do a one-stage procedure, one must always accept the probability of a multi-stage reconstruction. In this case, sometimes an implant/expander first can be later replaced by a flap reconstruction. The other question is whether you have enough soft tissue to do bilateral reconstruction and increase... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

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Comments (1)

Charlotterox 9 Aug 2012

Thanks all for your thoughtful and candid comments. I am not required to have radiation, due to the fact that I'm having a complete mastectomy and I have DCIS which is non-invasive. If I were to have a lumpectomy, which was originally recommended to me, I would have required 5 weeks of radiation.

In terms of tissue, I don't have enough on my hips to make larger breasts, but rather the same size I am now. The small implant will help to supplement and, according to the PS, will look very natural if combined with the hip tissue. My main worry is that it I've heard about the flap not "taking" and resulting necrossis. It seems there are no perfect solutions.

Thanks again for your input - it's very helpful

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