Patients opting for breast reconstruction following mastectomy: an analysis of uptake rates and benefit

Figures & data

Table 1 Breast reconstruction options, including advantages and disadvantages

Type	Specifics	Indications	Contraindications	Advantages	Disadvantages
Implant-based	Tissue expander or implant under the pectoralis muscle	Small breast with minimal ptosis Lack of donor tissue Patient preference	Previous radiation therapy Potential for anticipated radiation therapy	No donor-site morbidity Short operation, admission and recovery	Complications related to implant (eg, capsular contracture, implant migration) Visits for tissue expansion and second surgery to remove expander and place implant
Autologous	Pedicled: TRAM Free: TRAM, DIEP Other: gluteal flaps, thigh flaps	Redundant tissue Patient preference	Severe comorbidities Lack of donor tissue An excess of donor tissue (eg, large pannus)	More natural in appearance and feel Improved symmetry to contralateral native breast Better outcomes in patients requiring radiation than in implant patients	Longer operation, admission, and recovery Increased blood loss in the surgery Donor site complications Potential for partial or total flap loss
Combination	Pedicled latissimus dorsi flap with an implant	Not a candidate for autologous reconstruction alone Previous radiation treatments to the chest Patient preference	Atrophic or absent latissimus dorsi muscle	More natural appearance and feel than implant alone Latissimus dorsi muscle gives increased protection and vascularity against radiation	Morbidity at the donor site More invasive than implant-based surgery

Abbreviations: TRAM, transverse rectus abdominis myocutaneous; DIEP, deep inferior epigastric perforator.