Breast reconstruction options: implants or your own tissue?

I recently sat down with Dr. Rod Rohrich for his video podcast, Rohrich Knose Best, to talk about one of the questions I hear most: should I have implants, or reconstruction with my own tissue?

Neither option is better for everyone; it depends on the person. Implants usually mean a shorter operation and an easier recovery up front, but implants don’t last forever, so many patients need another surgery years later. Own-tissue reconstruction is a bigger operation, but the result is natural and permanent and changes with you over time. Although I’m known for own-tissue reconstruction, I actually perform more implant reconstructions.

The lower abdomen (the DIEP flap) is the most common donor site. For patients who are very thin or have had a tummy tuck, the thigh (PAP flap) or the flank (LAP flap) can still make own-tissue reconstruction possible.

It’s rarely one surgery. Many patients have two or three stages: sometimes a tissue expander first, then an implant or a flap, and finally refinements such as nipple reconstruction, fat grafting or reshaping.

Loss of feeling after mastectomy matters for safety as well as quality of life. With robotic nipple-sparing mastectomy, we noticed that sensation seemed better, and we’re now tracking it. Lymphedema is less common as fewer patients need a full removal of the underarm lymph nodes, and newer procedures to treat or prevent it are still being studied.

Look for a team that offers the full range of options, works closely with experienced breast surgeons and the rest of the cancer team, and cares about your whole recovery. And choose someone you’re comfortable with; you’ll see each other over about a year.