Natural Tissue Versus Implant-Based Breast Reconstruction: Knowing the Differences


Plastic surgeon and breast specialist Dr. Constance Chen discussed the potential complications of implant-based breast reconstruction, and how it compares to natural tissue reconstruction.

Around 80% of women who opt for reconstruction after losing a breast to mastectomy elect to reconstruct with implants rather than the superior natural tissue reconstruction, according to Dr. Constance Chen, a board-certified plastic surgeon and breast specialist in New York City.1

“Many women who have had unfortunate experiences with implants prefer not to try again, even with a different type of implant or modified surgical procedure,” Chen wrote on her blog.2“They turn to natural tissue breast reconstruction, also known as autologous reconstruction, which is the “gold standard' of breast reconstruction.”

With implant-based reconstruction, Chen noted 5 common complications women eventually deal with after surgery. All implants are foreign to the human body, with each posing their own risk to women depending on the patient’s individual requirements.

The first of these complications is infection around the tissue of the implant, which can typically develop in the days or weeks following surgery. A woman is at risk for infection because “there is no blood supply to the implant.” Treatment with antibiotics can usually solve the issue, but further infection-related problems could cause the necessity to remove the implant.

Second, capsular contracture is the formation of scar tissue as a natural reaction to the presence of a breast implant. Of all the complications Chen discussed, she noted that “most patients will at least experience capsular contracture at some point after implant reconstruction.” Most times, the capsule is soft and unnoticeable, but can harden and become painful over time. Treatment requires the removal of the implant, and sometimes “the implant may be replaced with a new one wrapped in acellular dermal matrix.”

Next, as the implant ages, it starts to degrade and becomes more likely to rupture. As long as the patient can tolerate a surgery, Chen suggests removing the ruptured implant to avoid further complications.

Fourth, displacement is common amongst implant-based reconstruction depending upon the placement of the implant. When the breast implant is placed under the chest muscle it can cause the implant to feel tight and painful, while flexing that muscle can shift the implant. Chen explained that “the action of the pectorals muscle also pushes the implant towards the armpit over time.” This is typically corrected by removing the implant and placing a new one above the chest muscle which is closer to the natural anatomy of the breast.

Finally, Chen explained that “most patients will also feel that their implants are cold, because there is no blood supply to the implant.” Fat-grafting is a limited solution to add additional padding around the implant.

Regardless, Chen affirms that natural tissue reconstruction is the superior choice for women because of the many potential complications seen with implant-based reconstruction methods.

While natural tissue reconstruction requires a more complex surgery and longer recovery time for patients, Chen noted that it “creates a soft warm breast that is usually aesthetically superior to an implant-based breast reconstruction, and it may also be possible to restore sensation after mastectomy.”

Even more, implant-based breast reconstruction is an easier surgery for plastic surgeons to perform, according to Chen. Almost all plastic surgeons can successfully perform an implant-based reconstruction, while the natural tissue reconstruction operation requires a more complex skillset. This leads to more women settling for implants than pursuing a natural tissue reconstruction.

“When a patient experiences any of these complications she should seek the advice of a plastic surgeon to see if she should remove or replace her implant or seek another type of breast reconstruction,” explained Chen.


1. Breast Reconstruction Specialist Dr. Constance M Chen Offers Tips for Patients. New York, New York. Published March 20, 2020. Accessed March 30, 2020.

2. Advances in Breast Surgery: Correcting Failed Implants. Published March 24, 2020. Accessed March 30, 2020.

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