Implant Based Reconstruction Page
Implant based breast reconstruction uses a saline or silicone implant to rebuild a natural looking breast. The procedure can be done at the same time as the mastectomy (breast removal surgery) or can be done at a later time when your cancer medical treatment is completed.
HOW IT WORKS
Consultation and Planning
Once you decide on mastectomy with your breast surgeon, you will come in for a reconstruction consultation. Upon choosing implant based reconstruction, we will make a plan specific to your medical needs and your personal goals. We will choose what breast size (bigger, smaller, or the same) you want to be, and we will coordinate surgery with your breast surgeon.
After the removal of your breast, there is not enough skin to create a similar sized breast. This tissue needs to be moved from another part of your body or the skin on your chest can be expanded to create a new breast. Implant based breast reconstruction has 2 parts: the expansion phase and the permanent implant with final touches phase.
The Expansion Phase
At the time of your mastectomy, a tissue expander will be placed underneath your chest muscle (pectoralis). The tissue expander is a temporary implant that can be filled to expand the tissue on your chest and create a breast shape (the breast mound). The expander is then filled with saline (salt water) at the end of surgery. You will have a drain on each side to remove clear, pink fluid from your surgery site. This drain is easily removed at your next office visit.
At your follow-up visits, a magnet is used on the outside of your skin to find the fill-port on the expander and saline is injected into the expander. Little by little, your expander is filled until you achieve the breast size you like. Now, you are ready for stage two.
The Permanent Implant
At a separate, outpatient surgery, the tissue expander is exchanged for a permanent, more natural-looking and natural-feeling implant. This is done through your same scar so that no new scars are made. This surgery lasts about an hour and a half and you can go home the same day. Usually, drains are not used. After your recovery, you are ready for nipple reconstruction.
Tissue expander surgery does not add any time to your hospital stay. After mastectomy, patients typically stay in the hospital for 1-2 days. The nurses at the hospital will give you pain medicine, make sure you are not nauseated and can eat, and teach you how to take care of your drains and bandages before you go home.
At home, you should not lift anything heavier than a gallon of milk for at least 2 weeks after surgery. You should walk around after surgery and NOT stay in bed. This is important to prevent blood clots. You may shower 48 hours after surgery. You should eat a healthy diet and as much protein as possible to promote good healing.
You may drive and return to work when you are no longer taking prescription pain medicine. Most people are able to return to a light duty job 1-2 weeks after surgery and sooner after the permanent implant surgery.
Remember that everyone is different. Recovery time and progression is not the same for everyone. The times stated are typical for healthy individuals healing from this surgery. The normal progression of healing may be different for those with health problems, smokers, and those who have unforeseen complications after surgery.
Risks and Considerations
Advantages of Implant Based Reconstruction
- Shorter surgery – 1-2 hours
- Faster recovery – go back to regular life faster such as working or caring for children
- Perky breasts – your reconstructed breast(s) will not sag and will always be youthful looking
Disadvantages of Implant Based Reconstruction
- Weekly office visits – although the visits are quick, you will come weekly for fills
- Perky breast – may not match your other breast or your body
- Not as natural looking/feeling as using your own tissue (TRAM flap link)
- Implant based problems (see risks below) including the risk of capsular contracture
With every surgery, there are risks involved including bleeding, infection, blood clots, pain, scarring, delayed healing and need for further surgery. Here are some complications specific to tissue expansion:
Infections in the presence of a tissue expander/implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the device may have to be removed.
Scar tissue, which forms internally around the tissue expander/implant, is normally soft and you cannot feel it, but it can tighten and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later and is not predictable. Radiation treatment to the chest wall greatly increases the risk of capsular contracture. This problem often requires surgery to treat.
Visible and palpable wrinkling of the expanders and breast skin can occur. This wrinkling is normal and expected in the expander and gets better as the expander is inflated. It may also be possible to feel the tissue expander fill-valve. The permanent implant may also be seen or felt. This occurs more often with saline implants and less often with silicone implants.
Implants of all types are manufactured products and can fail. They can deflate which causes them to change shape. This is repaired with further surgery to replace the implant. If they get infected, they may have to be removed.