Implants vs. Tissue for Breast Recontruction After Prophylactic Mastectomy

I am a 36 yo thin, healthy, small breasted, BRCA1+ woman. I am planning a prophylactic nipple sparing double mastectomy. Because I am healthy, my surgeons say that the choice is mine -- either option (implant or tissue) will work well for me. I am wondering which reconstruction option will offer a more natural look and feel for small breasts?

Doctor Answers 9

Implant vs. My Tissue for Breast Reconstruction After Prophylactic Mastectomy

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As noted by the other contributing physicians, this is a personal decision that should be made after taking your lifestyle and expectations into consideration.  For me, most of my patients made their  decision relative  recovery time, cosmetic result and concerns about implant problems and scarring.  For these reasons I would recommend the following approach for a young active woman contemplating prophylactic mastectomies and immediate reconstruction: Avoid Flaps and go with the Skin and Nipple Sparring Mastectomy with Immediate Reconstruction utilizing the High Tension Gel Implant and Alloderm. Reasons: 1.Much Faster Recovery (over night hospital stay) 2. Less Pain 3. Better Cosmetic Result 4.Much less scarring when compared to Flap procedures 5. High Tension Gel Implants offer less risk for future potential implant problems. 6. A ONE STAGE MASTECTOMY AND RECONSTRUCTION

Good Luck

Eau Claire Plastic Surgeon
4.7 out of 5 stars 22 reviews

Implants versus DIEP or TRAM for breast reconstruction

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Dear JCG - your question is probably one of the most asked and encountered by thin women seeking breast reconstruction.  In general, a reconstruction with your own tissue will be more natural and once it takes, the chances of problems are pretty much zero.  Implant reconstruction, however, works extremely well in small breasted women and the new implants are very natural.  The issue is that implants are artificial devices and have a known failure rate over a period of time.  So the choice is:  do you want to go through a big operation for an autogenous tissue reconstruction, or just go with implants with less recovery, knowing that you will probably need some type of revision down the road?  Unfortunately, only you can make this decision.  Hope this explanation helps you with your decision.

What is the Optimal Breast Reconstruction?

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The optimal breast reconstruction is a choice based on each patient's individual situation.  You are having bilateral prophylactic mastectomies and have not indicated that you have any medical issues that would preclude you from choosing any of the many breast reconstruction procedures available.

I tend to favor autologous breast reconstruction techniques as they don't use breast implants, and they make a warm, soft, natural breast using micro-surgical transplants of your own fat and skin tissues from you abdomen, buttocks, or inner thighs.  These procedures are called free flaps, perforator flaps and among the best known are the DIEP flaps.   

Other more traditional flap procedures use your own tissues, but may also include muscle along with the skin and fat.  Examples are the TRAM flap, and the Latissimus Dorsi Flap.  

For more information on these and other breast reconstruction techniques see

Fredrick A. Valauri, MD
New York Plastic Surgeon

Implants are best for breast reconstruction in thin women.

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Breast reconstruction with your own tissues is a very very big operation, which we reserve for ideal candidates only  (women who need a tummy tuck anyway). Otherwise, you create a deformity with long scar in the abdomen.

  For most women, implant reconstruction is safer and much easier on you and the results with well done surgery are very good.  This is our experience with several hundred patients.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

You have multiple options based on you tissue,size of your breast and your expectations

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I do offer both autologous breast reconstruction and implant reconstruction to my patients. The best result in long run can be achieved with the autologous breast reconstruction.You do not have to worry about the implant leak or rupture. I offer my patients DIEP flap if they have abdominal tissue for reconstruction. The advantage of the DIEP flap is ease of recovery and no abdominal muscle is used.

If you want to have quick recovery and plan to have pregnancies in the future,I would suggest implant reconstruction and possible DIEP in the future if you did not like the implants.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Implants vs. Tissue for Breast Recontruction After Prophylactic Mastectomy

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Very hard to advise over the internet. This is a very personal decision that should be based upon only in person evaluations with your reconstructive surgeon. Each has its positives and negatives as to results and risks. To directly answer the last part I recommend natural reconstruction for a more natural "feel' But the risks of the longer surgery time and poor results need to be fully understood. Good luck. 

Breast Reconstruction

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Your own tissue feels moore natural and needs less maintainance on the long run. ow ever the surgery might be more extensive depending on which tissue transfer you choose. You need to discuss all these issues with your plastic surgeon ahead of surgery.

Disuss each option

1: implants

2: Laismus Dorsi flap

3: Tram flaps

4: DIEP flaps

5: Other free flaps

The pros and cons of each and the risks benifit ratios, then you can make an intelligent decision

Samir Shureih, MD
Baltimore Plastic Surgeon

Immediate breast reconstruction with implant after prophylactic mastectomy

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Reconstructive options have improved tremendously in recent years due in large part to the use of acellular dermal matrix such as Alloderm to make an internal bra to support implants. This is an especially good option for nipple-sparing mastectomy and would lead to the quickest recovery. Thin patients may not have enough tissue for reconstruction with flap procedures using your own tissue, and these are much bigger operations.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Immediate breast reconstruction

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After a nipple and skin sparing mastectomy, you could have an immediate reconstruction . If your surgeon has the experience, the muscle could be expanded with the use of Surgimend (or similar collagen graft). The impland could then be placed under the muscle and graft. The size depends on your size. It does not have to be large. The skin will the be closed over the newly made mound. That technique usually works the best with the least amount of complications. I usually leave flaps for back up.Thanks, Luis Vinas MD, West Palm Beach

Luis A. Vinas, MD
West Palm Beach Plastic Surgeon
4.8 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.