Breast reconstruction after mastectomy: implants or DIEP flap

A mastectomy for breast cancer leaves a deep physical and psychological mark, and reconstruction is part of treatment, not a cosmetic extra. The key decision is between implant-based and autologous reconstruction, and it depends on prior radiotherapy, anatomy and the patient's priorities.

Silicone implant reconstruction is faster and less invasive, often staged with an expander. Its drawbacks are capsular contracture, shape changes over time and likely future replacements, plus poorer tolerance of an irradiated bed.

DIEP flap reconstruction (deep inferior epigastric perforator) uses the patient's own abdominal skin and fat through highly complex vascular microsurgery. Microvascular success is around 98%, giving a natural lifelong result with no rejection risk that ages with the patient; in exchange, surgery is longer and adds donor-site morbidity in the abdomen.

Spain and Germany host world-renowned elite reconstructive microsurgery units. South Korea stands out for aesthetic refinement in breast reconstruction. Prices range from EUR 6,000 to 15,000, with ten to fourteen day stays and mandatory coordination with the home oncology team.

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