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Implants offer a method for augmenting abdominal flaps in the setting of deficient volume in breast reconstruction. They may be placed immediately at the time of reconstruction or on a delayed basis. We seek to compare outcomes from a single surgeon and previously published studies.A systematic review was performed, querying multiple databases. A retrospective review was conducted for patients who underwent abdominal based flap breast reconstruction and implant placement between July 2005 and August 2015 by the senior author(MYN).A systematic review of the literature yielded four articles, for a total of 96 patients(142 breasts) included for systematic review. 87 breasts(61%) were reconstructed with immediate implant at the time of flap reconstruction and 55 breasts(39%) had a staged approach to implant placement. Complications were noted in 28 breasts(32%) following immediate placement and in 10 breasts(18%) following staged placement. A total of 53 patients(79 breasts) were retrospectively reviewed, all of which were reconstructed in a staged manner. Twelve breasts(15%) were found to have a flap or implant related complication. 97.5% of implants/flap reconstructions were successful, with a 54% revision rate. When pooling systematic and retrospective data, there was a significant difference in complication rates between the staged and immediate reconstruction cohorts(p < 0.001) in favor of the staged approach.The literature supports a higher rate of implant-related complications following immediate implantation at the time of flap reconstruction. Our experience with implant placement highlights the safety and effectiveness of the staged approach.