Breast Implant and Tissue Expander Reconstruction

Breast implants are a reconstruction option that requires minimal surgery. Unlike tissue flaps, no tissue is transplanted, and unlike TRAM or Lat Flap, no muscle is repositioned. When your implants are reconstructed, your new breasts will not have the same appearance and sensitivity as your natural breasts, and you will need more surgery to create new nipples and areolas. You may also need additional dilation treatments until the implant is the desired size.

Advantages and disadvantages of breast implant reconstruction

advantage

  • Reduce surgery, anesthesia and pain
  • Faster recovery than tissue transplant
  • No tissue or muscle repositioning

shortcoming

  • Implants don’t last a lifetime
  • Leaks and transfers are possible
  • the result is not perfect
  • Implant reconstruction does not sag with age

Good candidate for breast implants

Women who are overweight or obese may not be suitable for breast implant reconstruction. If you are an active smoker or drink a lot, implants may not be a good choice. Good candidates are:

  • Slim, Small Breasted Women
  • Women who prefer less risky surgery

Saline vs Silicone Implants

Most plastic surgeons will use saline and silicone breast implants. They are available in a variety of shapes, sizes and textures. When you consult with your surgeon about implants, ask if you can see and hold various sample implants. Note the difference in texture, drape, and flexibility. Ask which size and shape is best for the effect you want to achieve, and which size and shape work best for you. Keep in mind that no matter which method you choose, implants will not last throughout your life and may need to be replaced at some point.

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Primary Implants or Secondary Tissue Expanders

Breast implants are placed between the layers of the pectoral muscle, under the skin of the breast that will be preserved during a mastectomy. This can be done right after your mastectomy, or right after you have finished treatment. You may have relaxed muscle tone and elastic skin, which will allow for a one-stage implant reconstruction. However, if your chest skin and muscles are tight and well-toned, you may need a two-stage reconstruction process with expandable implants or tissue expanders, followed by permanent implants.

Planning a skin-sparing mastectomy

Before you have a mastectomy, your plastic surgeon will mark the lines on your breast skin for the incision. This will be a pointed oval that retains as much skin as possible and is safe to store. Since you may have some cancer cells in your nipple ducts, it’s not a good idea to try to keep your nipples, but your plastic surgeon can build a new one after you’ve healed from this surgery.

What Happens During Breast Implant Reconstruction

During reconstructive surgery, you will receive intravenous sedation or general anesthesia. Your general surgeon will open your skin following the skin marks and remove your breast tissue. He will be careful to remove enough tissue so that a clear margin will not leave any cancer behind. Your tissue will be sent for pathology.

Make room for your implants

Your plastic surgeon will use your chest muscles to create a pocket in which to place your implant. If you have enough space and skin to place a permanent full-size implant, you can place it at this time. But if your muscles are tight and you’ve lost more skin than new breasts, an expandable implant or tissue expander is placed.

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close breast incision

Once your breast implants are in place, your plastic surgeon will close your incision with dissolving sutures. This incision will be covered with plastic tape or other material to ensure the skin is closed with a flat, smooth line. A surgical drain can be placed near the incision to help remove excess fluid and promote healing.

Rehabilitation and Self-Care

Recovery from implant surgery is usually fairly quick. Some women only need a night or two in the hospital before being discharged. You will learn how to empty the surgical drain and record the amount of fluid. Your drain can usually be removed within a week of surgery. If you experience pain, be sure to tell your nurses and healthcare providers so they can treat you. Expect some pressure around the implant. Plan to wear loose, comfortable clothing on the way home. If you develop a fever or signs of infection, such as diarrhea, after surgery, call your healthcare provider for help.

enlarge your breast implants

Your new breasts may not get bigger immediately after surgery. If you have a tissue expander, you will need additional treatment to fill the implant to your desired size. Tissue expanders and expandable breast implants have a port through which the plastic surgeon can add saline to increase the size of the implant. You will return to the clinic regularly for dilation treatments until the implant is a little bigger than you want. This extra dimension allows the skin to stretch and sag in its natural curve when the smaller permanent implant is in place. The expansion may be mildly painful as the pressure inside the implant increases, but lessens as the surrounding tissue stretches.

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Breast Implants for Double Mastectomy Reconstruction

Breast implants are a quick way to rebuild your breasts after a double mastectomy. You spend significantly less time on the operating table with anesthesia and dual implant placement than with alternative tissue flap reconstructions (TRAM, latissimus dorsi flap, DIEP, SGAP).

Special Considerations for Implants

Radiation: After your breast surgery, if you need radiation therapy to target your breast area, you will be at increased risk of hardened scar tissue forming around your implants.If you know you will need radiation, tell your plastic surgeon that you prefer an implant with a plastic (rather than metal) port to inject saline. Metal ports reflect radiation back to nearby tissue, potentially causing skin damage.
Scar tissue: Over time, pockets of tissue can form around any implant, but if capsular contractures (very hard scar tissue) develop, you will need the help of a surgeon to correct the condition.
Limited Use: Breast implants of any type can leak with age and need to be replaced.