Immediate reconstruction. Implants or flap??

I have to have mastectomy with no follow up radiotherapy or chemo, so am very very lucky.
I have to choose between implant or flap reconstruction
Looking for pros and cons of each if any one has any?
Many thanks xxx

Hello Twinks


Here’s my contribution to your debate with yourself!  I am awaiting recon with a DIEP flap after an earlier mastectomy with no RT or chemo either.  I have a temporary expander in place saving my skin - I had another minor on-going health issue which meant I wasn’t a good candidate for immediate recon (too long op time).


Are you having a unilateral or bilateral MX?  The answer may influence your choices.


Implants - would you be able to achieve symmetry?  I would never get anything to match my good side (D/DD).  Secondly, implants have a lifespan which may mean you need them replacing after 15 years or so.  Easier operations to put in place but things can go wrong, like capsular contracture, etc.


Flaps - are you fat enough?  I am borderline but it can be done if I have symmetrising surgery on the good side.  Longer and trickier op with much longer post op recovery time and of course, things can still go wrong. Most likely to be a one time only option, I.e. no going back to replace implants later if a tummy flap used.  With me, it’s the best option that will give me something that looks like the good side and if I lose or gain weight, my recon will follow suit.  Downside of flap recon is that you create a scar on another part of your body although you might think a tummy tuck as a BOGOF is a good plan!


Have you been given a copy of the BCC booklet on breast reconstruction?  Well worth a read if not and can be downloaded from this website.  It’s pamphlet BCC7.  Also, speak to your BCN, she should be able to show you some pictures of completed reconstructions.


You have my sympathies in having to choose and make a decision.  Fortunately, mine was made for me as soon as my consultant said an implant would never achieve symmetry!


Ezzie. X

Hi Ezzie
Thank you SO much for your timely and very informative reply.
Gosh you have been through a lot too, and still more to come.
My right breast is to be removed and it it naturally the bigger of the two anyway. I am a very small 36a ( prob could be a aa) I like your spirit and laughed at BOGOF ? thank you.
I am going to my GP today to see if he has any information then meet with BCN and team on 23rd.
Thank you Twinks x

Thank you SO much Evie,
Yes it seems to be very individual to each person and I will look up support group
Thank you xx

Hi Twinks, Emily here from Someone Like Me at Breast Cancer Care. 


I just wanted to let you know that we have telephone and email volunteers who have finished their treatment and have chosen either implant or flap reconstruction. They’re happy to speak to people who need to make this decision and are weighing up the pros and cons. 


If you’d like to speak any of them on the phone, then just drop us your contact details** here** and we’ll get in touch to make arrangements.

Hope this helps

Emily x

Hi Twinks


I was a 34B. Surgeon recommended Lat Flap recon, as good for smaller sizes. Didn’t have fat for Diep or other options anyway. But only ever wanted implant recon for the following reasons:-


No extra scars elsewhere on my body, therefore quicker healing and less risk of infection. Recovery time’s quicker.

No extra scar on the breast area, other than the original mast scar.

Didn’t want to compromise the back muscle strength as I’m skinny and it’s my strongest muscle.

Implant shapes are better now and the use of “Strattice” or tissue matrix adds extra support and smoothes the implant edges.


Had I had immediate or delayed recon with my first mast, the initial surgeon said he could “tittivate” the remaining breast to match the implant one, but it wasn’t needed, as I had to have a 2nd mast a year later. So both were to be delayed implant recons. Am still only at the expander stage, but ready for replacement with perm silicons and matrix slings/support, when I can get my bum and mind into gear for it.


It’s a load to get your head round with all the considerations, pros and cons, and yes, looking at lots of photos of results will help.

Good Luck with your decision and resultant surgery.

Delly xxxx


Hi Della,
Gosh you have been through a lot. Thank you and all the other ladies for all your kind help and support.
Twinks x

Hi Twinks, it is such a difficult thing having to make this decision, but the other ladies have given you great advice. I thought I’d share my story as I’ve had both implant and DIEP reconstruction!

So, September 2014 I was diagnosed and went for immediate reconstruction with implant (34b) as I have back issues so didn’t want LD flap, and no belly fat (I was a size 8 at the time). The recovery was quick and just one scar across centre of breast. It was rather perkier than my saggy 47 year old side which had endured 2 years of breast feeding! But it was good not to be flat and not needing to worry about prosthetic. I was back driving and doing yoga after 3 weeks.

I subsequently had chemo and rads. I had to have the implant removed during chemo as the wound and implant became infected.

I was left with a deflated balloon mound of skin, saved for later use. Between chemo and rads I had an expander put in to restretch the skin, this was done with a second scar in the breast crease underneath. My oncologist wanted a max 6 weeks between chemo and rads but this ended up being 12 to allow for recovery from chemo before surgery, healing post surgery and expansion of the implant.

8 months post rads I had the expander replaced with a permanent teardrop shaped implant. This had to go over the muscle as the muscle was very tight and scarred from previous surgery. The result was a bit of a lumpy breast - like icing a fruit cake without the marzipan!! I had an uplift to saggy at this point. The result wasn’t bad, again better than using prosthetic but not natural looking.

Roll on a couple of years, add a stone or two in weight, now a size 12, 36C and the difference between the implant and natural breast was significant.

At the end of August I went for a DIEP. Tummy fat was limited but surgeon took it all and got a decent match (although still a little smaller now the swelling has gone). Because of my thin radiotherapied skin he was not able to join the flap to the existing scar so I have an oval scar around the whole breast which is disappointing. 10 days in hospital, no lifting, stretching, driving or work for six weeks, pretty uncomfortable for the first two weeks and have to be careful not to stand up straight which puts strain on abdominal scar. I’ve got a pretty go result, nice flat, tight tummy as my bonus prize! The surgeons going to do some lipofilling/sculpting to sort out a dip caused by previously damaged pec muscle.

I went back to work this week, about 7 weeks post op. Haven’t returned to yoga, horse riding or any formal exercise yet as still need to be careful.

So, sorry for waffling on. Personally the DIEP does give a more natural result in the long term. It’s very worthwhile trying to get to a Keeping Abreast meeting if you can. I went along the week before my op and was grateful to hear first hand experiences from other ladies and a chance to see results after only 3 weeks for some.

Good luck making your decision and with your surgery. Happy to answer any specific questions you have on either option.


Hi Everyone
I have now seen the plastic surgeon and breast care nurses. Thank you all for your help and support.
I have decided to have the DIEP following my mastectomy. Feel so much better now that I have that decision behind me.
Twinks xxx

Hi Evie-S,
How are you? Hope all is well.

Hi Evie-S,
I would like to know when there are responses on this site. I thought I had notifications on, but I guess not as I missed your response. If you have any tips for that please share…thanks. I did start the remaining chemo sessions and I have one more to go in another 2 1/2 weeks. Still need to make an appointment with radiologist.

I’m happy that you’re getting to the gym. Great way to get in shape and relive stress.

Hello to all you lovely ladies,


Hope you’re all doing well, are you?  Let us know if not. Am sure we can all help, whether support, advice or sympathy.


Twinks - Hope all’s going well for you ref your recon surgery, following all your considerations !! Please do let us know how you are, when you’re able, up to and want to!  As well as me, I don’t doubt everyone else is also keen to know. 


I’ve just read through all of our advice. Wish I’d had it all for my own decisions, cos it’s all such brilliantly helpful good stuff. But am so glad we can pass on it on and be of some help to future uns. And is all part and parcel of the reason why this Forum is so wonderful. Yey to whoever started it !!


Good to see you again Riverside. We’ve had few exchanges in the past, over this and that. All good wishes to you for good health and happiness.

That goes for the rest of you all too

Humblepeace - I too am not receiving post or email responses. Have asked mods to look into. With their patient help, thought we’d sorted, but it isn’t yet. Pointed me to “My Profile”, top right of page. Next to  your name and “Sign out”. Click on that, then "Subscriptions/Notifications, then click on Notifications. There are a no. of box options that then come up. Tick those that fit. But, as said, I’m still not getting myself when I used to all the time. Good Luck with and please let me know if you find the magic reason before I do. I’d very much appreciate it, taaa.


Much love to all of you’s

Dellywellydoodaah xxxxxxxxxxxxxx

Thank you Delly and all ladies who have comments

I have opted for the DIET reconstruction at the time of mastectomy and am just waiting on the date for it now. It’s all the waiting, waiting!
I have attended a local breast cancer support and doing yoga and relaxation along with pamper sessions too.
Thank you all.
Twinks x

Thanks Evie-S,
I just found your post due to looking back and remembering I had asked a question. I’ll have to get better at navigating this site. Thanks for your support

Hi Girls,

Twinks and Humblepeace, how are you both getting on? Where are you up to with “things” or your boobs, to be more precise?? Would you pop on when you have the time, and let us know. Am keen to know what’s been happening.

Hope all’s well with everyone on here.

Delly xxxxxx

Hi Delly
I am two weeks post surgery now. Mastectomy with reconstruction and DIEP flap.
All wounds healing well and just picked up my Tamoxifen prescription but not starting till after Christmas.
Hope you are all well xxxx

Hi Delly,
Sometimes I feel, yip I’ve got this, sometimes I feel “ what the hell just happened thete?” All a bit surreal!
I sometimes feel like screaming, this is **bleep**!
So, all in all I think I am coping with it as fine as any of us ?
Thank you so much xx

Hi I am now booked in for a mastectomy and immediate implant reconstruction. I optryfot this because of (hopefully quicker recovery time) and I have small boobs and my surgeon says we will get a good result. Having the op on Tuesday, do you think I will Be upto joining in the Xmas festivities? Has anyone had this and if so how soon did the drains come out? Thanks Jane

Hi Jane, yes quicker recovery time. I think a few days in hospital ( in Scotland anyway)
I had the mastectomy and recon with DIEP and was out on day 5.
Drains out Day 2 breast and Day 4 abdo.
You will be tired but should be able to enjoy Christmas xx

Hello Lovely Ladies


Wow Janemc - What a great self Xmas pressie !!! Good “get out” clause too, as you’ll be having to take it very easy. Perhaps wear a tin bra to prevent your delicate knocker from getting knocked. Hope all goes well with your op, recovery and final results of.

Lotsa love to everyone

Delly xxxx