Implant Based Reconstruction
Placement of tissue expander
Implant Based Reconstruction begins at our Spokane practice with placement of an adjustable tissue expander beneath the skin of the breast. The tissue expander may be placed above (“pre pectoral”) or below (“sub-pectoral”) the pectoralis muscle. Patients typically are discharged home on the day of procedure, even when tissue expanders are placed at the time of mastectomy. The acute recovery period is approximately three weeks with an expected return to normal activities by 6-8 weeks. Drains are present in the breast after surgery. Drains are usually removed within two weeks of the breast reconstruction procedure.
Tissue expanders may be placed at the time of mastectomy immediate reconstruction or after mastectomy, when you have previously healed flat delayed reconstruction.
Sequence of tissue-expander based reconstruction.
Inflating Tissue Expanders
Healing from the initial tissue expander placement typically takes 3-4 weeks. You will have regular followup with your surgeon during this time. At 3-4 weeks, your surgeon will begin the expansion process. The tissue expander is filled with saline over a two to three sessions spaced at least one week apart. The saline injections are performed in the office during a standard post-operative visit and typically cause minimal discomfort, similar to a sore muscle, that resolves over 1-2 days.
The tissue expander is typically filled by 4-6 weeks after surgery. Your surgeon will then allow a period of time for the skin to stretch, settle, and recover.
Replacing Tissue Expanders with Implants
The tissue expander is replaced with a saline or silicone gel breast implant. This typically occurs at 5-6 months from when the tissue expander was placed. The permanent implant gives a softer and more natural-appearing result. The procedure to exchange your tissue expander for a permanent implant is typically performed on an outpatient basis and has a healing time of 2-4 weeks. Drains are not typically used for this surgery.
Before & After
Patient with history of right and left mastectomies with right chest radiation. She had staged reconstruction with abdominal based free flaps and nipple/areola reconstruction.
After reconstruction with implants has been completed, you should continue to monitor the appearance and texture of your breasts. Over time, appearance and texture can change. Forty percent of women undergo another operation for their implants by seven years after their reconstruction.
Reasons for further operations:
Capsular contracture, or hardening of the tissues around the implant, is the main reason for further operations. Capsular contracture occurs in 30% of women who choose implants for breast reconstruction and may happen shortly after implants are placed, several years after reconstruction, or not at all.
Implants are not able to withstand the stresses placed upon them by the body to last for your entire life. The chance of rupture is low, but over years or decades, an implant will likely fatigue and ultimately develop a hole. When this happens, a saline implant will deflate. A rupture in a silicone implant is not easily detectable. Because of this, some women choose to follow the FDA recommendation to monitor their implants for rupture with MRI studies.
Because of the long-term considerations with implant reconstruction, most women do undergo further operations to maintain their implants. Most of these are outpatient procedures with a relatively quick recovery.
Am I a good candidate for Implant-based Breast Reconstruction?
Implant-based breast reconstruction is not a good option for patients who have previously been treated with radiation because of poor aesthetic outcomes and a high likelihood of healing problems.
For patients who require radiation after mastectomy and placement of the tissue expander, the timeframe to proceed with the additional steps in implant based reconstruction may be prolonged. Radiation increases the risks of healing problems and infection in the implant-reconstructed breast. It also increases the risk of capsular contracture from 30% to 60%.
Before & After
Breast reconstruction after nipple sparing mastectomy using implants (split pectoralis technique).