All of Your Breast Reconstruction Options Compared

Tissue expander inserted between skin and muscle. After desired size is reached, expander is replaced with saline/silicone based implant. Some women can have an implant directly inserted.

Breast is reconstructed by stripping muscle, fat and skin from your abdomen, back, or buttocks area and attaching it over the breast area.

BRAVA external tissue expander is used prior to surgery. Breasts are shaped by fat injections (autologous fat transfer), which is harvested directly from the patient through liposuction.

2 separate operations
2-4 hours per procedure under general anesthesia.Multiple office injections to inflate expander over a period of 4-6 months. Longer for radiated breasts.

Usually need additional implant exchanges and/or touch ups and/or fat gafting.

1 major operation
4–10 hours for DIEPS and microsurgical flaps under general anesthesia. 3–4 hours for TRAM and latissimus flaps under general anesthesia.

Usually need additional touch ups and/or fat grafting.

1–4 outpatient procedures
for non-radiated breasts.

4–6 outpatient procedures
for radiated breasts. Depends on the degree of tissue damage.

1-2 hours per procedure under general anesthesia.

Compliance with BRAVA wear reduces number of procedures required.

1 day surgery or overnight

Average 2–3 days
for pedicled TRAM.

Average 5 days
for microsurgery and free DIEP.

No hospitalization

2 weeks
after each procedure. + 3–5 days after each touch up.

Medium range pain

6-8 weeks
after major procedure. No straining or lifting. + 3-5 days after each touch up.

Medium range pain
on two sites

1-2 weeks
after each procedure

Minimal breast pain
Liposuction pain similar to sore muscles from an intense workout.

1 new scar
Mastectomy scar plus implant scar.

2 new scars
Patch-like scar around edges of flap. Scar from flap donor site.

No new scars
Improved appearance of mastectomy scar. Liposuction body contour benefit.

Less natural look. Firmer over time.

More natural look. Some natural feel. Soft.

Most natural look. Feels natural and soft.

No sensation

Minimal sensation

Near-normal sensation

Frequent Procedures
needed to match opposite breast. Traditionally recommended for small-medium size breasts.

Few Procedures
needed to match opposite breast Traditionally recommended for larger breasts.

Fewer Procedures
needed to match opposite breast Recommended for all breast sizes

Most Complications
40–70% will need another operation to modify or remove implant within 8 to 10 years.

Great risk of rupture/deflation, calcification, capsular contracture, implant erosion, painful scar tissue, wrinkling.

Some Complications
Low risk of complete failure of pedicled TRAM but significant risk of delayed wound healing.Hard areas from fat necrosis.

Microsurgical flaps and DIEPS have 5–10% risk of emergency re-operation to save threatened flap loss.1–3% risk of total flap loss even in very best surgeon’s hands.

Abdominal weakness, bulge, and hernias may occur. Implant often needed in very slender patients and always needed in latissimus flaps.

Fewest Complications
Some fat loss. Some oil cysts that can be aspirated.

Most Drawbacks
Foreign objects in body.

Frequent need for revisions.

Very high failure rate and not recommended in radiated breasts.

Lifetime maintenance.

Many Drawbacks
Highly dependent upon surgeon’s skill and experience. Result still often feels and looks like a patch.

Limited donor sites except in women who already need a tummy tuck.

Occasional need for implant to reach adequate volume.

Fewest Drawbacks
Highly dependent upon patient compliance with the use of the BRAVA expander.

Need multiple small procedures to grow back the breast.

Radiated breasts need 1 year to complete the reconstruction

3-4 out of 5
Often look better than they feel.

2-3 out of 5
Good. Occasional need for implant to reach adequate volume.

5 out of 5
Excellent. Patients feel they’ve “regenerated” back their breast.

Yes

Yes

Yes
Might have to “educate” insurance on new procedure and should avoid coding liposuction (just like TRAM avoids coding tummy tuck).

High
2 expensive hospitalizations

Cost of implant & expander.

Cost of extremely expensive dermal substitutes. (Alloderm® or others that are now almost always used.)

High failure rates with need for multiple surgeries.

High
Very expensive, intensive, complex operation and hospitalization.

Runaway costs in 10–20% with complications.

Still frequently requires more than one outpatient touch up.

Low
Much cheaper, smaller outpatient procedures, even if 4 are needed.

Predictable costs because of minimal risk of costly complications.

Becoming first choice method by the cost-conscious HMO carriers.