Breast Implant Reconstruction
Another form of reconstruction to discuss with your medical team are breast implants. Women with larger breasts could require a combination of a tissue flap reconstruction and an implant. In some cases, your surgeon might recommend an implant for your uninvolved breast to improve symmetry. Your surgeon might also recommend a breast reduction or a breast lift on the uninvolved breast for the same reason. If it is very important to you that your unaffected breast is not altered, you should discuss this with your surgeon as soon as possible, as it may affect the reconstruction methods used in your care.
The breast reconstruction process may begin at the time of your mastectomy (immediate reconstruction), or weeks to years afterwards (delayed reconstruction). Immediate reconstruction may involve placement of a breast implant, but typically involves placement of a tissue expander, which will eventually be replaced with a breast implant. It is important to know that any type of surgical breast reconstruction may take several steps to complete.
Discuss the advantages and disadvantages of the following options with your surgeon and your oncologist:
* Immediate Reconstruction:
One-stage immediate reconstruction with a breast implant (implant only).
Two-stage immediate reconstruction with a tissue expander followed by delayed reconstruction several months later with a breast implant.
* Delayed Reconstruction:
Two-stage delayed reconstruction with a tissue expander followed several months later by replacement with a breast implant.
One-Stage Immediate Breast Implant Reconstruction
In this reconstruction option, the plastic surgeon will insert the breast implant at the time of your mastectomy and after your surgeon removes your breast tissue.
Two-Stage (Immediate or Delayed) Breast Implant Reconstruction
The most common form of reconstruction using implants is a two- stage procedure. Either at the time of the mastectomy or at a later date, a breast tissue expander is placed. Several months later it is replaced with a breast implant.
Generally both skin and breast tissue are removed during a mastectomy, which leaves the chest flat and tight. In order to create a place for the breast implant, a tissue expander is placed under the remaining chest tissue.
A tissue expander is a balloon-like device made from elastic silicone rubber. It is unfilled when inserted, and over time a sterile saline fluid is added using a small needle through the skin to the filling port of the device. As the tissue expander is slowly filled, the tissue over the expander begins to stretch, in a fashion similar to the way a woman's abdomen expands gradually during pregnancy. This expander creates a place for the implant.
The placement of the expander is generally done under a general anesthesia in the operating room and takes one or two hours. You may be required to stay in the hospital briefly, or it may be done on an outpatient basis. Normal daily activity can generally be resumed after two to three weeks.
If your chest skin is numb from the mastectomy surgery, you might not feel any pain from the placement of the expander. You may, however, feel pressure or discomfort after each filling, but this subsides as the tissue expands. The tissue expansion period typically lasts four to six months.
After the tissue expander is removed, the breast implant is placed in the pocket. 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.