Implant Reconstruction vs. Flap Reconstruction: Which Is Better?
For women who have undergone a mastectomy, professionals recommend breast reconstruction to restore appearance and self-esteem. While a minority of women may prefer to remain flat-chested or use prosthetics, most will opt for a breast reconstruction procedure. There are two primary reconstruction procedures, implant reconstruction, and flap reconstruction. Which is better depends on the circumstances and to an extent on personal preferences.
What is Implant Reconstruction?
Implant reconstruction uses a silicone or saline breast implant to replace the removed breast tissue. This is the most common type of breast reconstruction (in 2019, 80% of procedures used implants). This is a similar procedure to breast augmentation.
Implant reconstruction sometimes involves reconstructing both breasts to avoid asymmetry.
What Is Flap Reconstruction?
Flap reconstruction is also called “autologous” reconstruction. In this procedure, the surgeon takes tissue from another part of the body, usually the tummy, back, buttocks, or inner thighs. Professionals move the tissue to the patient’s chest, formed into the shape of the breast, then stitched into place. Many women prefer to have the tissue moved from the abdomen because it also flattens their stomach. However, where tissue is taken is influenced by body type and where women carry extra fat and tissue. In pedicled flap surgery, the surgeon literally moves the extra tissue under the skin. In free flap, the tissue disconnects then reconnects.
So, which is better? It really depends.
Pros of Implant Reconstruction
- Generally, implant reconstruction results in fewer post-surgical complications. With flap reconstruction, you are adding procedures to move the tissue from the donor site.
- Implant reconstruction’s popularity and use within cosmetic surgery cause more availability in qualified surgeons.
- It generally requires a shorter recovery and a shorter hospital stay. Implant surgery is a simple procedure, and the patient will only stay overnight. Because of this, implant reconstruction is also cheaper for the patient and easier for the hospital. Flap reconstruction generally requires a three-day stay and considerably more downtime.
- Flap surgery is contraindicated for patients who are obese, smoke, have a history of blood clots, or who have had certain previous surgeries. This leaves implant surgery the only option for many women.
- Reimbursement rates are higher for implant reconstruction, with a disparity of anywhere up to 1,000%, despite flap reconstruction being the more complicated procedure. Unfortunately, this means that some women who would prefer flap reconstruction may be unable to afford it.
- Some women who have had flap reconstruction become unsatisfied with the appearance of the donor site, especially if it is the tummy. While many patients desire the “tummy tuck”, later scarring that develops may, for example, affect appearance when wearing a bikini and impact self-esteem and body satisfaction.
- Professionals insert the implants through the mastectomy incision, resulting in fewer scars.
- For some patients, the ability to increase breast size may be helpful for self-esteem. Implant reconstruction suits larger breasts better as flap reconstruction requires more tissue from the donor site. In some cases, it may not be possible to find enough tissue to reconstruct a larger breast.
Pros of Flap Reconstruction
- Generally, a better and more natural appearance, resulting in higher patient satisfaction. There is less risk of having to also reconstruct the other breast so they match.
- Implants generally last about 10 years. Especially for younger women, this will mean additional surgery to replace the implant in the future. Flap reconstruction lasts a lifetime.
- There is no risk of an allergic reaction with flap surgery. It also avoids the risk of breast implant illness, which is caused by a reaction to silicone (saline implants still have a silicon shell), which can cause serious chronic symptoms, sometimes years after implants are inserted, and can only be treated by removal of the implants. Women with a personal or family history of autoimmune conditions or severe allergies should consider flap reconstruction. Indeed, these women may have a higher risk of developing BII.
- There is no risk of implant leakage, which can cause saline implants to deflate, and, with silicone implants, can cause pain, swelling, and visible changes in breast shape and size. Implants may also shift in position. Women with silicone implants have to be screened for silent rupture, which involves imaging with ultrasound or MRI every two to three years. insurance does not always cover this and expenses add up.
- Radiation therapy can cause issues with implants, including capsular contracture (scar tissue forming around the implant), skin thinning, and even implant intrusion. Flap reconstruction does not come with these problems. (Another alternative is to hold off on breast reconstruction until after the radiation treatments are complete.)
- The patient’s breasts will change size naturally with normal weight gain and loss (some women might consider this a disadvantage).
- Flap reconstruction may be better for patients with naturally smaller breasts who would prefer not to enlarge them.
Which procedure is better depends on a number of factors which might include insurance, ongoing treatment, and the patient’s body type and preferences. Breast reconstruction needs to be discussed with patients early and their choices should be respected (including the choice not to undergo breast reconstruction).
Neither procedure restores full sensation to the breast. Although women who have had flap reconstruction generally report a better sex life due to the improved appearance and texture.
Regardless of the surgery type, surgeons should consider using the ONETRAC Single-Use Cordless Lighted Retractor with Integrated Smoke Evacuation. Smoke evacuation is particularly important for breast procedures, helping protect those in the operating room from associated health risks. To find out more about how ONETRAC can help you, contact obp today.