Comparison of Oncoplastic Breast Reconstruction Options

PROCEDURETIMINGAPPROXIMATE LENGTH OF SURGERYWHO IS A GOOD CANDIDATE?PROSCONS
IMPLANT ALONEImmediate (only for small implant)1 hourWomen with small to medium breasts with enough excess skin left over after mastectomyNo extra scars, fast placement, immediate final results, unlikely to delay radiation and chemotherapyDoesn’t have natural breast consistency; may have high position without natural droop; hard to customize size without initial use
of expander; can dislodge, wrinkle, leak, encapsulate, cause pain; implant usually has to be replaced in 10 to
20 years; cosmetic outcome may be compromised by radiation
TISSUE EXPANDER FOLLOWED BY IMPLANTImmediate or delayed1-2 hoursThin women who don’t have enough extra fat or skin for autologous reconstructionNo extra scars, fast placement, unlikely to delay radiation and chemotherapy, an option for smokers or women with circulatory problemsFinal results happen many months after mastectomy; tissue expander may need multiple injections; second surgery required if expander is replaced by permanent implant; doesn’t have natural breast consistency or droop; implant can dislodge, wrinkle, leak, encapsulate, cause pain; implant usually has to be replaced in 10 to 20 years; cosmetic outcome may be compromised by radiation
TRAM FLAPImmediate or delayed3–8 hours, depending on surgical skills and whether blood supply remains intact or needs to be reattached with microsurgeryWomen with enough extra skin and fat in belly;
non-smokers who don’t plan on getting pregnant		Feels like a natural breast; get tummy tuck as a side benefit; most breast sizes can be recreatedExtra scars; longer surgery and anesthesia; longer recovery; delays radiation and chemotherapy; can cause fat necrosis, hernia, persistent breast and belly pain, and abdominal weakness; can be done only once; not for smokers, women with a history of diabetes, women with circulatory problems, or women who want to become pregnant
DIEP FLAPImmediate or delayed5–8 hoursSame as TRAM FlapSame as TRAM FlapSame as TRAM Flap
SIEA FLAPImmediate or delayed5–8 hoursSame as TRAM FlapSame as TRAM FlapSame as TRAM Flap
GAP FLAPImmediate or delayed9–12 hoursWomen with enough extra skin on buttocks and hips; non-smokers with no history of diabetesFeels like a natural breast; most breast sizes can be recreated; can be done more than once; good choice for women who want to become pregnant or have had abdominal surgery alreadyLong operation with risk of more complications; higher risk of tissue breakdown; can be done only
by a plastic surgeon skilled in microsurgery techniques; can cause fat necrosis; could delay radiation and chemotherapy; usually causes some pain and discomfort while sitting
PAP FLAPImmediate or delayed3-5 hoursWomen with small to medium breastsFeels like a natural breast; incisions are easily concealed; good choice for women who want to become pregnant or have had abdominal surgery alreadyRelatively new procedure so some surgeons may not have experience with it; thigh skin texture may be different from chest skin; long operation with more possible complications; higher risk of tissue breakdown; can be done only by plastic surgeon skilled in microsurgery techniques; could delay radiation and chemotherapy; pain and discomfort in pelvic area
TUG FLAPImmediate or delayed5-8 hoursSame as PAP FlapSame as PAP FlapSame as PAP Flap
LATISSIMUS DORSI FLAPImmediate or delayed3–6 hoursWomen with small to medium breastsSimpler operation than TRAM flap; feels like a natural breast; good choice for women who want to become pregnant or have had abdominal surgery alreadyRecovery takes longer than implant surgery (but less time than TRAM flap surgery); can cause fat necrosis; may cause discomfort and limit vigorous back and shoulder activity; can be done only once; could delay radiation and chemotherapy

Source: Breastcancer.org – All rights reserved