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| Implant Reconstruction |
Breast implants come in a variety
of shapes, surface textures, and sizes. Depending
on the desired shape you wish to achieve. You
and your plastic surgeon may choose a round or
shaped breast implant shape. Generally, the larger
you want your cup size, the larger the breast
implant the plastic surgeon will consider (measured
in cubic centimeters, or cc's).Your plastic surgeon
will also evaluate your existing tissue to determine
if you have enough to cover the breast implant.
If you desire a breast implant size too large
for your tissue, the plastic surgeon may warn
you that breast implant edges may be apparent
or visible post-operatively.
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| Types and Stages
of Implants |
If your surgeon recommends the
use of an implant, you'll want to discuss what
type of implant should be used. A breast implant
is a silicone shell filled with either silicone
gel or a salt-water solution known as saline. The
breast reconstruction process may begin at the
time of your mastectomy (immediate reconstruction) or weeks to years afterwards (delayed reconstruction).
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Immediate
Breast Implant Reconstruction |
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Immediate
one-stage breast reconstruction may be done at
the time of your mastectomy. After the general
surgeon removes your breast tissue, the plastic
surgeon will then implant a breast implant that
completes the one-stage reconstruction. In breast
reconstruction following mastectomy, a breast implant
is most often placed sub muscularly.
Some potential advantages to immediate reconstruction
are both emotional and aesthetic . |
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Some
women wish to avoid the mastectomy deformity and
find that immediate reconstruction helps reduce the
distress associated with the loss of a breast. |
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During
immediate reconstruction the general surgeon who
removes the breast, and the plastic surgeon, who
reconstructs the breast, work together to preserve
breast skin (skin-sparing technique) which produces
the best results. When less skin is removed during
mastectomy the scars are often easier to conceal.
An additional benefit is that women can recover from
the mastectomy and breast reconstruction simultaneously,
without the need to take additional time off work. |
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Immediate
reconstruction is also cost saving. |
However,
there may be a higher risk of complications such
as deflation with immediate reconstruction, and
your initial operative time and recuperative time
may be longer. It is important to know that any
type of surgical breast reconstruction may take
several steps to complete
For immediate reconstruction, 2 operations are usually
needed. |
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The
first allows the mastectomy and reconstruction to
occur at the same time. If the natural breast needs
to be enlarged, reduced or uplifted to match the
reconstructed breast, that operation is done at the
same time as the immediate reconstruction. |
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The
second operation to create the nipple is done about
4 to 6 months after the breast reconstruction. The
nipple and areola reconstruction operation is optional
but when done it gives the plastic surgeon an opportunity
to improve breast symmetry and to refine the appearance
of the donor site by improving the scars or removing
excess tissue if needed. |
| • Delayed
Breast Implant Reconstruction |
Breast reconstruction
usually occurs as a two-stage procedure.
Stage 1: Tissue
Expansion
Stage 2: Placing
the Breast Implant |
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A tissue expander is inserted following the mastectomy to prepare for reconstruction. |
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| Stage 1: Tissue
Expansion |
During a
mastectomy, the general surgeon removes
skin as well
as breast tissue, leaving the chest tissues
flat and tight. To create a breast shaped
space for the breast implant, a tissue
expander is placed under the remaining
chest tissues. The tissue expander is
a balloon-like device made from elastic
silicone
rubber. It is inserted unfilled, and
over time, sterile saline fluid is added
by
inserting a small needle through the
skin to the filling port of the device.
As the
tissue expander fills, the tissues over
the expander begin to stretch, similar
to the gradual expansion of a woman's
abdomen during pregnancy. The tissue expander
creates
a new breast shaped pocket for a breast
implant.
Tissue expander placement usually
occurs under general anesthesia in
an operating room. Operative time is generally
one to
two hours. The procedure may require
a brief hospital stay, or be done on
an
outpatient
basis.
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The expander is gradually filled with saline
through an integrated or separate tube to
stretch the skin enough to accept an implant
beneath the chest muscle. |
Typically, you can resume normal daily activity
after two to three weeks. Because the chest
skin is usually numb from the mastectomy
surgery, it is possible that you may not
experience pain from the placement of the
tissue expander. However, you may experience
feelings of pressure, tightness or discomfort
after each filling of the expander, which
subsides as the tissue expands but may last
for a week or more. Tissue expansion typically
lasts four to six months. Some expanders
are designed to be left in place as the final
implant. The nipple and the dark skin surrounding
it, called the areola, are reconstructed
in a subsequent procedure. Some patients
do not require preliminary tissue expansion
before receiving an implant. For these women,
the surgeon will proceed with inserting an
implant as the first step. |
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| Stage 2: Placing
the Breast Implant |
After
the tissue expander is removed, the unfilled
breast
implant is placed in the pocket, and
then filled with sterile saline fluid.
In reconstruction, following mastectomy,
a breast implant is most often placed
sub muscularly. The surgery to replace
the tissue expander with a breast implant
(implant exchange) is usually done
under general anesthesia in an operating
room.
It may require a brief hospital stay
or be done on an outpatient basis.
Potential advantage to delayed reconstruction
is
that you can delay your reconstruction
decision and surgery until other
treatments, such as radiation therapy and
chemotherapy
are completed. Delayed reconstruction
may be advisable if your surgeon
anticipates healing problems with your
mastectomy
or if you just need more time to
consider your options. There are medical,
financial
and emotional considerations to choosing
immediate versus delayed reconstruction.
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After
surgery, the breast mound is restored.
Scars are permanent, but will fade with
time. The nipple and areola are reconstructed
at a later date. |
You should discuss with your surgeon, plastic
surgeon, and oncologist, the pros and cons
with the options available in your individual
case. Women who postpone reconstruction may
go through a period of emotional readjustment.
Just as it took time to get used to the loss
of a breast, a woman may feel anxious and
confused as she begins to think of the reconstructed
breast as her own. |
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| For delayed
reconstruction 3 operations are needed. |
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The
first is the mastectomy, |
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Second
is the breast mound reconstruction, and an operation
to balance the size or shape of the breasts. |
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The
third is to create nipple and areola is optional
but highly recommended to give the best outcome. |
| With all
forms of reconstruction, complications may require
additional surgery. The need for further surgery
beyond the initial reconstructive procedures is usually
higher in implant reconstruction cases. |
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