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?

Doctor Answers 6

Breast reconstruction

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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 the size of your breasts. If you end up requiring an implant to augment a flap procedure, you defeat the primary purpose of having the flap, i.e. getting rid of the implant issue.

Bilateral immediate free flap reconstruction is a long and tedious procedure. In general, implant reconstruction (unless you require radiation) will be a reasonable choice, especially if you can coordinate your surgeons to do a skin-, or even nipple-, sparing mastectomy.

Robin T,W, Yuan, M.D.

Beverly Hills Plastic Surgeon

Options for Breast Reconstruction

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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.    

Essentially you are not burning any bridges with implants.   In addition, we are now using fat grafting after our implant reconstructions to allow for a more natural look. 


I wish you a safe and healthy recovery.


Dr. GIll

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Breast reconstruction options

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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 want.  You should discuss all breast reconstructive options with your plastic surgeons as there are many variables to consider.  Find a plastic surgeon who is board certified by American Board of Plastic Surgery who is very familiar with breast reconstruction.

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

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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 breast must take into account:

  • a woman's body type
  • her fat distribution
  • details of the breast cancer
  • whether the skin and the nipple/areola tissue can be saved
  • her past medical history
  • whether she has had chemotherapy and/or radiation therapy
  • her personal aesthetic goals

Both implants and flaps have specific risks and benefits, and not every woman is a candidate for each procedure. 

Occasionally, a combination of a flap and and implant is performed to achieve a woman's specific goals, such as yours.  Generally, the flap is performed first and an implant is placed beneath the flap 6 months later to "augment" the reconstruction. 

Seeking a consultation with a Board-Certified Plastic Surgeon who offers ALL the available options for breast reconstruction, including implant reconstruction and Microsurgical breast reconstruction (which does not sacrifice major muscles of the body) is a wise thing to do!

Please visit my website for additional information about the options for breast reconstruction.

Karen M. Horton, MD, MSc, FACS, FRCSC

Plastic Surgery, Aesthetic Surgery, Reconstructive Microsurgery

Karen M. Horton, MD
San Francisco Plastic Surgeon

Breast reconstruction options

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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 such as a DIEP flap.  Hope this helps.

Dr. Basu

Houston, TX

Breast reconstruction

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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
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.