Breast Implants and Tissue Expander Reconstruction

Breast implants are the option for reconstruction that requires the least surgery. Unlike a tissue flap no tissue is transplanted, and unlike a TRAM or Lat Flap, no muscle is relocated. When your implant reconstruction is complete, your new breast won't have the same look and sensitivity as your natural breast, and you will need more surgery to create a new nipple and areola. You may also require additional expansion treatments, until the implant reaches the desired size.

Advantages and Disadvantages of Breast Implant Reconstruction

Pros

• less surgery, anesthesia, and pain
• faster recovery than tissue transplantation
• no relocation of tissue or muscle

Cons

• implants don't last a lifetime
• leaking and shifting is possible
• results are not cosmetically perfect
• implant reconstruction does not sag as you age

Good Candidates for Breast Implants

Women who are overweight or obese may not be good candidates for breast implant reconstruction. If you are an active smoker or use large amounts of alcohol, implants may not be a good choice. Good candidates are:

• slender, small-breasted women
• women who prefer less risky surgery

Saline Versus Silicone Implants

Most plastic surgeons will work with saline as well as silicone breast implants. These are available in several shapes, sizes, and textures. When you consult with your surgeon about implants, ask if you can see and hold a variety of sample implants. Note the difference in texture, drape, and flexibility. Ask which size and shape are best for the result that you want to achieve, and what kind will be most comfortable for you. Remember that whichever you choose, an implant won't last for your lifetime, and may have to be replaced at some point.

One-Stage Implant or Two-Stage Tissue Expander

A breast implant may be placed between layers of chest muscle or above the muscle but under the breast skin during your mastectomy. This can be done immediately after your mastectomy, or after you've completed treatment. You may have relaxed muscle tone and stretchy skin, which would 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, using an expandable implant or a tissue expander followed by a permanent implant.

Planning a Skin-Sparing Mastectomy

Before your mastectomy, your plastic surgeon will mark your breast skin with the lines to be used for your incision. This will be a pointed ellipse that will spare as much skin as is possible and safe to keep. Since your nipple may have some cancer cells in the ducts, it is not a good idea to try to keep your nipple, but your plastic surgeon can construct a new one after you've healed from this surgery.

What to Expect During a Breast Implant Reconstruction

You will have intravenous sedation or general anesthesia during your reconstruction surgery. Your general surgeon will follow the skin markings to open your skin and then remove your breast tissue. They will be careful to take enough tissue in order to get clear margins so that no cancer is left behind. Your tissue will be sent to pathology for examination.

Making Room for Your Implant

Your plastic surgeon will use your chest muscles to create a pocket with that will hold your implant; new methods allow the implant to be placed above the muscle. If you have enough space and skin for the permanent, full-sized implant, it can be placed at this time either above or under the muscle. But if your muscles are tight and you've lost more skin than will cover the new breast mound, an expandable implant or tissue expander will be placed.

Closing Your Breast Incision

Once your breast implant is in position, your plastic surgeon will close your incision with dissolving sutures. This incision will be dressed with plastic tape or with another material that will ensure that the skin closes in a flat, smooth line. A surgical drain may be placed near your incision, to help remove excess fluid and promote healing.

Recovery and Self-Care

Recovery from an implant procedure is usually fairly quick. Some women need to stay in the hospital only one or two nights before being discharged. You will learn how to empty your surgical drains and to record the fluid volume. Your drains can usually be removed within a week of surgery. If you are having pain, be sure to let your nurses and healthcare provider know, so they can offer you treatment for this. Expect to have some sensation of pressure around the implant. Plan on wearing loose, comfortable clothing on your trip home. If you develop fever or signs of infection, such as diarrhea, after your surgery, call your healthcare provider for help.

Expansion of Your Breast Implant

Your new breast may not be full-size immediately after surgery. If you have a tissue expander, you will need additional treatments to fill out the implant to your desired size. Tissue expanders and expandable breast implants have a port through which your plastic surgeon can add saline, to increase the implant's size. You will return to the clinic at regular intervals for expansion treatments, until the implant is a little bigger than the size you want. This extra sizing allows for skin to stretch and droop in a natural curve, when the smaller, permanent implant is in place. Expansion can feel slightly painful as pressure increases from within the implant, but as your surrounding tissue stretches, the pain will abate.

Breast Implants for Double Mastectomy Reconstruction

Breast implants are a quick way to reconstruct breasts after a double mastectomy. You will spend much less time under anesthesia and on the operating table having double implants placed than you would if you opted for tissue flap reconstruction (TRAM, Latissimus dorsi flap, DIEP, SGAP).

Special Considerations about Implants

Radiation: After your breast surgery, if you need radiation therapy aimed at your breast area, you face an increased risk of developing hardened scar tissue around your implant. If you know that you will need radiation, tell your plastic surgeon you prefer an implant with a plastic (instead of metal) port for saline injection. A metal port will reflect radiation back onto nearby tissue, possibly causing skin damage.
Scar Tissue: A tissue capsule will form around any implant over time, but if capsular contracture (very rigid scar tissue) develops, you will need help from your surgeon to remedy this condition.
Limited Use: Any type of breast implant may develop a leak as it gets older, and will need to be replaced.