Breast Implant Reconstruction
What is breast implant reconstruction?
In this way, breast reconstruction following mastectomy can be performed either with immediate placement of silicone implants (rarely), or in two stages which is the most common. Initially, we use a tissue expander which slowly stretches the tissue of the chest wall to a suitable size and shape and then at a later date (usually after 2-3 months) we replace the tissue expander with a permanent implant.
Advantages and disadvantages of the method:
The advantages of this method are the following:
- there are no incisions and donor site morbidity (such as in autologous flap reconstruction)
- it is a less invasive technique which requires less operating time and consequently faster recovery
However, this method has also disadvantages such as:
- the implants have less “natural” texture and look
- the implants cannot be compared with the natural breast droop
- the reconstruction might be longer (months), requiring many visits at the doctor’s office for stretching chest wall tissue and requiring at least another surgery for the placement of the permanent implant.
- there are the same potential risks as in breast augmentation such as infection, implant rippling, implant rupture, bottoming out and implant animation.
Who is a good candidate for breast implant reconstruction?
Candidates for a breast implant reconstruction are the following:
- patients not suitable for autologous flap reconstruction
- patients who do not want additional scars
- patients who prefer faster recovery (despite the fact that usually these patients undergo 2 operations)
- patients with small breasts
Relevant contraindications of this method are the following:
- patients who have undergone (or will undergo) breast radiotherapy
- patients with very thin skin
- patients who would like a more “natural” breast.
What to expect at your first appointment:
At your first appointment, you will discuss:
- your past medical history regarding breast cancer, data about the histological classification of the tumor, if you had lymphadenectomy as part of your treatment, as well as any further therapy you had in case of mastectomy.
- the remaining medical history, if you are on any medication, vitamins or other herbal supplements, if you have any allergies or any other operations in the past
- if you smoke (if the answer is yes, how many cigarettes per day).
Afterwards, Dr Karmiris:
- will evaluate your general health condition and any other risk factors
- will examine you and will take all the detailed measurements from your breast, your chest, as well as your scar if you already had mastectomy.
- will take preoperative photographs
- will discuss with you all the possible surgical options, depending on your case
- will discuss with you all the possible risks or potential complications, as described in the international literature and finally
- will discuss with you about the anaesthetic plan.
Preoperative check includes mainly blood tests, chest X-ray, electrocardiogram (ECG) and any other specialized tests, depending on the case.
Also, it will be necessary to stop smoking preoperatively, and immediately post-operatively as well as avoid taking aspirin and any anti-inflammatory medicine, since they increase the risk of bleeding.
The surgical procedure is performed under general anaesthesia and the same incision of mastectomy is used. The tissue expander or the implant is placed underneath the pectoral muscle in the majority of cases. Incisions are closed with absorbable sutures of different types. Then, the tissue expander slowly stretches the tissue of the chest wall with periodic infusion of saline through a port, at doctor’s office. As soon as the suitable size and shape is achieved, the tissue expander is replaced by a permanent implant at a later stage (in about 4-6 months).
At this stage, we can also treat the unilateral breast in order to create symmetrical result, depending on patient’s wishes. If the nipple has been removed during mastectomy, it can be reconstructed at a later date under local anaesthesia.
Dr Karmiris will explain you, in detail, the whole surgical procedure and will answer any questions related to that.
Immediately after the surgical procedure, you will have medical gauze or bandages on the incisions which will be reduced, gradually. If drains have been used, they will be removed in a few days. You will need to wear a surgical bra in order to minimize swelling and support your breast during recovery.
In most cases, patients are discharged the same day. Dr Karmiris will give you particular instructions on how to take care of your incisions immediately post-op, what medication you should take and when you will be seen for a follow up.
Then, a few sessions will take place at doctor’s office (usually every 2-4 weeks), during which saline will be injected to the tissue expander in order to stretch slowly the tissue of the chest wall before the final surgery (usually after 4-6 months).
Risks and safety information:
In general, breast implant reconstruction, is a safe surgical procedure which is performed with great success. However, like any other surgical procedure, breast implant reconstruction has some risks, as well as potential complications that every patient should be aware of and should understand fully, before entering the operating room.
The most important potential complications are the following:
- bleeding or haematoma in about 1% of patients
- wound infection
- risk of poor scaring
- capsular formation (scar tissue which is formed around the implant)
- rippling of skin and/or bottoming out
- implant rupture
- general risks from anaesthesia, such as deep vein thrombosis, cardiac or pulmonary complications.
Regarding the safety of silicone implants, there are extensive scientific studies, made by independent University Institutions, which have shown that until nowadays, there is no correlation between silicone implants and autoimmune or other systemic diseases.
Last years, US Food and Drug Administration (FDA), has been monitoring the correlation between certain types of breast implants and a rare form of non-Hodgkin’s lymphoma, the anaplastic large cell lymphoma (ALCL).
For the time being, the data are under evaluation and the certified incidents are very rare (approximately 1 in 30.000 cases), while the majority of them can be cured. Dr Karmiris will answer any questions related to that.
Finally, it’s important to state that silicone implants are not lifetime devices and may need to be replaced in the future.