You have several questions which can be answered with several answers: "Your own tissue" vs. (Gel) implants vs. "your own tissue" and implants.
You will need to seek the opinion of a Plastic Surgeon well versed in the different approaches.
He can than "tailor" the best possible approach for you.
All implant reconstructions will require maitainance, that is future surgery regardless of the implant type.
Autologus tissue reconstruction may need two or three surgeries to achieve symmetry and cosmesis, but after that no maintainance is required.
Free tissue transfer is very good especiall in bilateral reconstruction, they are long complex surgeries.
Now a new method is gaining more poularity is FAT TRANSFER for breast reconstruction, May require two to three cessions but it utilizes your own fat and will not need any further surgery once the size and shape is achieved. These are simpler procedures.
If you are a candidate Bilateral Latismus Dorsi muscle flaps without implants, if you have enough bulk, will require no maintainance, but may be a small breast. You have an implant so the implant can be taken out and the space is filled with the latismus dorsi Myocutaneous flaps.
Get evaluation for Breast Implants or Free Flap Reconstruction
Your question is impossible to answer over the net. See a boarded plastic surgeon. My opinion is to go with the implant reconstruction IF YOU ARE A CANDIDATE. The free flap is a long operation with very high risks. Best of luck.
Free flap vs implant reconstruction
It is a question of autologous tissue reconstruction vs. implants. In my mind, autologous tissue reconstruction hands down feels more natural and looks more natural in the majority of cases.
Free flap vs implant reconstruction
There is no doubt that free tissue transfers make better breasts when all goes well. These are complex procedures and should only be done by those who do them frequently. Bilateral cases are twice as complex and you need to have a good lower abdominal donor site to be a candidate. There are other tissue sites which can be harvested but the abdomen is the workhorse for sure. The tissue flaps feel more natural, look more natural and can be resculpted if needed over time.
Form-stable implants vs. free flaps for breast reconstruction
The good news is that there are much better implants to use for reconstruction than saline; the bad news is that the FDA has really dragged their feet on approving the form-stable implants (Mentor CPG, Allergan 410.) Advantages of implant reconstruction include the fact that it can be done as an outpatient surgery with minimal recovery time. Given that you have coverage issues and a history of contractures, I would suggest looking into using a material called Alloderm to give better coverage and support while minimizing the risk of recurrent contracture.
The advantage of free flap reconstruction is that it uses your own tissue, assuming that you have adequate tissue in a suitable donor site. The disadvantage is that it is a long surgery with a much longer recovery. On balance, I am more in favor of implants for that reason, especially given that you need bilateral reconstruction. It is possible that you might be able to find a surgeon who has acccess to the form-stable implants as part of the clinical trial.
No need to wait for the 410 Allergan breast implants
The silicone implants that available at this time are as good as 410. You will get the same result from available silicone implant.
The other option is free flap breast reconstruction.This is more involved surgery and has longer recovery. The results from free flap reconstruction are more natural( your own tissue from the abdomin is used) and also there is no need for the implant use.
The best option is to talk to your plastic surgeon and let him help you with the right choice for you.
Secondary breast reconstruction
The easy answer is if you don't want surgery again at age 65-70 don't get implants since there is always a risk that you will need surgery 15-20 years later for many different reasons. It is not a given, but it is always a possibility if not an expectation. However, free flap surgery, the gold standard, is not a simple procedure but it is the most natural and long-lasting. Get a comprehensive consultation with a surgeon who does both and explore the pros and cons of all the methods of reconstruction. If you have very thin tissue, a latissimus flap may be helpful as well.
First of all, biting off a bilateral free flap reconstruction is a lot so talk with some patients who have had it done before choosing this alternative.
Second, the size of your reconstructive breasts will be limited using bilateral autologous tissue. Be sure to understand the size you'll be as it may be smaller than you want.
Third, 17 years is a good long time for implants to last. Will you really care at 70 years old if you have some capsular contracture. Hopefully, you'll be a vigorous, active 70 year old but you need to ask how important soft breasts will be to you then.
Finally, for the majority of patients the CPG or style 410 implant is desirable but just because its new and of limited availability. Be sure you understand what this implant feels like before you sign on for it.
Hope I'm not too much of a wet blanket but, please go into this with both eyes open.