Choosing the type of breast reconstruction that is right for you

Breast reconstruction can be done with:

• Breast implants (filled with saline or silicone)
• Natural tissue flaps (using skin, fat and muscle from your own body)
• A combination of these methods 

There is no one best reconstruction method. There are pros and cons to each. For example, breast implants require less extensive surgery than procedures using your own body tissues, but the results may look and feel less natural [119]. There are fairly few complications with any of the current techniques.  

Your body shape and anatomy may affect the types of breast reconstruction likely to give you the best results. For women with larger breasts, breast reduction surgery on the opposite, natural breast may also be needed to create a more even look. Your plastic surgeon will help you choose the type of reconstruction that will give you the best results. Although this decision may seem overwhelming, it may help to know that most women who have had breast reconstruction are happy with the method they chose [119].  

Most breast reconstruction methods involve several steps. Both immediate and delayed reconstructions require a hospital stay for the first procedure. However, follow-up procedures may be done on an outpatient basis.

Timing of breast reconstruction

Breast reconstruction can help restore the look and feel of the breast after a mastectomy. Performed by a plastic surgeon, breast reconstruction can be done at the same time as the mastectomy ("immediate") or some time after the surgery ("delayed").  

Many women now get immediate breast reconstruction. However, the timing depends on your situation and the treatment you will have after surgery. Not all women are candidates for immediate reconstruction. It is important to discuss your options with your plastic surgeon, breast surgeon and oncologist (and your radiation oncologist if you are having radiation therapy).

Benefits of breast reconstruction

Breast reconstruction can help you feel more comfortable about how you look. Although a reconstructed breast may never match the look or feel of your original breast, this area of plastic surgery continues to improve.

Smoking and breast reconstruction

Smoking increases the risk of complications for all types of breast reconstructive surgery [119-120]. If you smoke, talk to your plastic surgeon about problems with wound healing and problems with flap procedures that may occur.

Basic types of breast reconstruction

The table below compares the basic types of breast reconstruction. Specific types of reconstruction are discussed in more detail below.

	Breast implants	Natural tissue flaps (grafts)
Looks and feels like a natural breast	Less able to mimic the look and feel of a natural breast (silicone implants look and feel more natural than saline implants)	Better able to mimic the look and feel of a natural breast
Loss of sensation	Will likely lose some sensation in the breast	Will likely lose some sensation in the breast and tissue donation site
Surgery	Less extensive Time in surgery is shorter	More extensive Time in surgery is longer DIEP, SIEA, S-GAP and I-GAP procedures require well-trained microvascular surgeons
Is a hospital stay needed?	Needed for the first procedure Follow-up procedures may be done on an outpatient basis	Needed for the procedure (longer stay than with implants)
Will the procedure need to be repeated?	Implants will likely need to be replaced during lifetime.	Tissue flaps will not need to be replaced during lifetime. However, if there are complications, some procedures cannot be repeated.
Recovery	Two to three weeks Fewer scars	Three to six weeks More scars
Risk of complications	Some risk of surgical complications	Some risk of surgical complications (certain procedures have more risks than others)