Breast Reconstruction Flap vs Implant Method

From New Orleans Breast Reconstruction Surgeon – Dr. Taylor Theunissen

Breast cancer is one of the most common types of cancer in the country (according to the National Cancer Institute), striking about 1 in 8 American women over their lifetime. An estimated 316,950 new cases of invasive breast cancer will be diagnosed in women this year alone. These dire statistics underscore the need for informed decisions when it comes to treatment and subsequent breast reconstruction.

Roughly 50 – 60% of mastectomy patients opt to move forward with breast reconstruction in order to improve body image, self-esteem, and psychological well-being. The reconstruction procedure may be performed at the same time as the mastectomy (immediate reconstruction), though most patients choose a delayed reconstruction. One key decision each patient must make is the type of reconstruction they want. According to Dr. Taylor Theunissen, the best New Orleans breast reconstruction surgeon, breast cancer survivors usually have two options: autologous flaps or implant-based reconstruction.

Implant-Based Reconstruction

This type of breast reconstruction entails the use of silicone or saline implants to recreate the breast mound. The reconstruction procedure often involves a two-stage process. A tissue expander is first placed to gently stretch the skin and muscle. A second surgery is then performed to swap the expander for a permanent implant.

Implants are the most common method. According to a 2024 report published on the National Library for Medicine, approximately 80% of reconstructions are implant-based. This high prevalence highlights widespread use and acceptance.

Pros of Implant Breast Reconstruction

Some of the key advantages of breast reconstruction using implants include the following:

• Shorter surgery time (typically 1-2 hours per breast) and quicker recovery—many women return home the same day.
• No donor site scars or muscle loss from other body areas.
• Adjustable size during the process, allowing for symmetry with the natural breast.
• Ideal for thinner women who do not have enough tissue for flaps.

Cons of Implant Breast Reconstruction

A few drawbacks of implant-based breast reconstruction include the following:

• May feel less natural than tissue flaps
• Comes with risks, such as capsular contracture (hardening of scar tissue around the implant), in up to 10-15% of cases.
• Higher complication rates after radiation, including a 29% failure rate in radiated patients.
• Implants may need replacement every 10 to 15 years, resulting in additional surgeries.
• Rare risks like breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) (which affects about 1 in 3,000-30,000 women with textured implants).

Flap Reconstruction (Autologous Tissue)

Autologous breast reconstruction uses your own tissue, skin, fat, and often muscle—from another part of your body (like the abdomen, back, or thighs) to create a new, natural-feeling breast. The most common type is the DIEP flap (Deep Inferior Epigastric Perforator) that uses abdominal fat and skin while preserving the underlying muscle. This is a complex microsurgery that requires specialized expertise and skill.

Although flap breast reconstruction is less common than implants, this is considered the “gold standard” because it yields a natural result. A landmark study published in JAMA Surgery found that patients who underwent autologous reconstruction reported higher long-term satisfaction and better psychological and sexual well-being compared to those with implants.

Pros of Flap Reconstruction

• More natural look and feel, as the tissue ages and changes with your body (e.g., gaining/losing weight).
• Higher satisfaction rates: Women with flaps report greater satisfaction, especially post-radiation, with fewer complications in long-term studies.
• No need for replacements; success rates are 96-99% for procedures like DIEP flaps.
• Bonus benefits, such as a “tummy tuck” effect from abdominal flaps.

<h2> Cons of Flap Reconstruction

• Longer surgery (6-8 hours) and recovery (4-6 weeks), with two surgical sites and potential donor-site issues like abdominal weakness or hernias.
• Not suitable for everyone. Requires enough donor tissue. Very thin women or those with prior surgeries may not qualify.
• Higher short-term complication risk (e.g., 47% in two years), including flap necrosis (tissue death) in 1-4% of cases.
• More expensive initially, with costs potentially 20-30% higher than implants.

How to Make a Choice That’s Right for You

The right choice depends on personal factors like body type, health, and goals:

• Your overall health and cancer treatment plan (e.g., need for radiation therapy).
• Your personal priorities – is it a shorter surgery, or a result that feels most natural decades from now?

An important step is to consult a board-certified plastic surgeon who is highly skilled in both advanced microsurgical flap techniques and implant reconstruction. The surgeon will be able to objectively evaluate your unique anatomy and goals to guide you toward the path that aligns with your vision of healing.