Breast reconstruction is about creating symmetry. We want both sides of the chest to look the same. If a bilateral mastectomy is needed, I usually suggest an implant reconstruction so both sides will be similar in appearance and feel. A bilateral tissue reconstruction would require double the donor site and healing, making it a second choice.
General health and other factors play roles in choosing which reconstruction is right. Obesity, diabetes, and smoking all make reconstruction more difficult in general, and especially in tissue reconstruction. Previous surgeries and scarring of the abdomen and other locations can reduce the options for tissue reconstruction. Radiation treatment to the chest can cause skin changes that make implant reconstruction difficult.
Defining your goals is one way to think about which is right for you. To look symmetrical in clothes, you may only need an external prosthesis. But if you don’t want to wear an artificial breast, an implant could be more appropriate. If looking good naked is important, a tissue-based reconstruction will give the most natural look and feel.
Should you use your own body’s tissue or an implant for breast reconstruction? When my patients want my opinion, I usually refer to an interesting survey of female plastic surgeons. When asked which method would they choose if they needed a breast reconstruction,1 most (66%) chose implants so they could return to work faster. Cosmetic outcome was the most important reason for those who chose their own body’s tissue. On a slightly lighter note, most surgeons with a BMI over 30 chose to use autologous reconstruction.
