Implant Breast Reconstruction Surgery
Implant based breast reconstructions is one of the most common techniques we use to restore a breast after mastectomy. The surgery most often involves placing a temporary adjustable expander under the skin and muscle of the chest wall. Over time, usually several months, this temporary expander is filled with fluid. This is performed by placing a small needle through the skin and into a built in port that is built into the expander and filling with standard IV saline. Since the skin over a mastectomy site is usually numb after removing the breast the needle placement is not painful. The result is a space in which we later place a more permanent implant. The exchange requires a second, short, outpatient surgery.
The advantages of this reconstruction is that it requires no additional surgical sites; all the surgery is done through the same incisions that were made for the mastectomy. The surgery is about one hour and much less involved than flap surgery. The recovery period is relatively short, compared to some of the more extensive techniques such as flap surgery or micro-surgical reconstruction. Most patients are up and around in a couple of days and back to full activity within two weeks. It is often a good option for bilateral breast reconstructions because we can easily match both sides for symmetry. We can achieve symmetry with one sided reconstructions by performing a breast reduction, lift, or augmentation on the other side. There is usually less overall discomfort than major flap reconstructions. Hospitalization for the first surgery is 1-2 days and the second surgery is outpatient.
Disadvantages of Implant Reconstruction
The disadvantages of a purely implant reconstruction include issues pertaining to implants themselves, including the risks of implants. The most common are visible or palpable implant rippling, asymmetry, scar tissue around the implant (capsular contracture), implant rupture, and infection. The process does take several months or more to complete, but during that time there is a breast mound created by the tissue expander that can fill out your bra and clothing adequately. The expansion requires weekly visits to the office to add the fluid requiring a significant patient commitment.
In the correct patient and situation, this technique can provide very nice reconstructions with very acceptable risks and little downtime.