Muscles – Keep them, you need them!
The pectoralis major, latissimus dorsi and rectus abdominus muscles are important core muscles of the trunk. Keep them, you need them! There are many other reconstructive methods that can provide you with a pleasing reconstruction without muscle sacrifice.
Placement of breast implants beneath the pectoralis major muscle results in abnormal movement of your reconstruction site when using your arms.
The latissimus flap is commonly combined with a breast implant and therefore is associated with all of the subsequent complications and unplanned re-operations of implant failure.
The TRAM flap is associated with the use of synthetic mesh or dermal allographs in an attempt to avoid abdominal wall hernias and buldging. Synthetic mesh has been associated with soft tissue infections.
These are reasons why you may prefer not to undergo either of these operations.