Whether a woman chooses implants or an autologous flap procedure, there are benefits and risks for each that should be thoroughly discussed with her physicians. It is important to research each procedure and discuss any concerns or questions with a qualified plastic surgeon and oncologists who are experienced in breast reconstruction and breast cancer treatment.

For a woman who chooses implants, whether they are filled with silicone gel or saline, there are some disadvantages:

• Hard envelopes of scarring can occur around the implant
  
  
• Reconstructed breast can feel overly firm
  
  
• Breast area can be quite tender
  
  
• Implants may interfere with future mammograms and breast self-examinations
  

The advantages of a flap procedure include:

• Implant is usually not needed
  
  
• Usually a single operation can create a soft breast composed of a patient’s own tissue
  
  
• Women who carry extra weight in the abdomen can achieve a tummy tuck (abdominoplasty) as well as breast reconstruction

The disadvantages of reconstruction with a flap include:

• Longer time in surgery and recuperation
• Greater risk in delay of healing
• Breast area and skin flap removal are involved in healing

The question becomes which patients are the best candidates for a flap. Several criteria are used in screening women for a flap procedure. There are a few contraindications, meaning conditions in which this type of surgery would not be advised, including: 

• Previous abdominal surgery (e.g. appendectomy or gallbladder incision). Since the newer surgeries utilize less invasive laparoscopic techniques, this factor is less of an issue.
  
  
• Diabetes. Individuals with diabetes do not heal as well and are considered higher risk for infection and complications.
  
  
• Smoking. Smokers tend to absorb nicotine in their lungs, which is a vasoconstrictor. The nicotine can cause the smaller blood vessels in the breast, which keep the flap alive, to constrict. The constriction jeopardizes the health of the breast.
  
  
• Lack of fatty tissue in the abdomen. Without adequate tissue, there is not enough skin to use in the procedure.
  
  
• Obesity. Too much fat and subcutaneous tissue makes it too difficult to use the skin for the flap.

Some women opt for the TRAM flap over implants because the procedure includes an abdominoplasty and also because they avoid some of the potential drawbacks of having an implant. It is a U.S. Food and Drug Administration (FDA) requirement to tell all prospective patients who consider saline or silicone implants that there is a risk of deflation, infection, hardness of the area and that the implants may have to be changed, which would require an additional surgical procedure.

Other potential risks of breast reconstruction include the possibility of:

• Rupture or deflation of an implant
  
  
• Additional surgery to replace a damaged implant
  
  
• Needing to replace an implant at a future date
  
  
• Infection
  
  
• Implant rotation under the skin
  
  
• Capsular contracture (scar tissue that forms and compresses the implant, making it hard and unnatural looking)
  
  
• Poor wound healing
  
  
• Tissue death (the flap dies due to insufficient blood supply)