Breast Reconstruction with Implants

What is Breast Reconstruction with Implants?

The most important thing for you to realize, whether you decide to have any breast reconstruction at all, is that you have choices. You will choose whether or not you are going to have a reconstruction, and most women have a choice of what type of reconstruction. You can also choose a reconstruction to be done later, after a mastectomy, although the results are not as attractive in general. I think this choice itself is a very important factor for a woman in terms of regaining control of her life after being told she has breast cancer.

The second thing to remember is that unfortunately, although most breast reconstruction results are good, there is nothing that I can do to give you back your lost breast in any real way. Much of the sensation of your breasts is lost, and although there is a gradual increase in sensation, it will never be normal. You are not likely to forget that you had to go through the trauma of a mastectomy and a reconstruction. However, a reconstruction can help to simplify your life in terms of clothing, bathing suits, bras, exercise, body image, and improve emotional wellbeing. For many women considering breast reconstruction in Richmond, restoring confidence and feeling more comfortable in everyday life are just as important as the physical reconstruction itself.

For patients considering breast reconstruction in Richmond, more and more we may elect to bypass the expander stage and go straight to an implant. This is sometimes only possible in small to medium-breasted women for reasons of blood supply. Most patients will still have a second procedure to adjust symmetry or for the added benefit of fat grafting, so I cannot promise just one stage, although direct to implant is generally less painful than an expander.

Two things have happened in my practice in the last few years to enable me to do at least 90% of my implant-based practice “Direct to Implant” or DTI. The first is having a “delay procedure” to preserve and enhance the blood supply to the mastectomy flaps. (Please see “A Discussion about Nipple Delay” in the Discussions section and “Surgical Delay of the Nipple Areolar Complex in High-Risk Nipple-Sparing Mastectomy Reconstruction” under Publications on my website.) The second is that Johnston Willis Hospital acquired an imaging machine called “SPY” to help assess blood flow to the mastectomy flaps accurately at the time of surgery instead of guessing.

Tissue Expanders and Implant Reconstruction

Not every patient is a candidate for direct-to-implant breast reconstruction in Richmond, and your surgical plan will be tailored to your anatomy, health history, and cancer treatment.  A tissue expander is basically a partially deflated, temporary implant which is placed under the mastectomy flaps.  This can be done either at the time of the mastectomy, three months, or many years later, depending on the patient.  Associated with the expander is a valve, which is on top of the implant.  This valve is under the surface of the skin.  Once the skin has healed enough (about one week), the expansion process can begin.  This will involve anywhere from one to six sessions in which the skin over the valve is injected with a small needle and a certain amount of injectable saline is placed in the tissue expander.  Each woman is different; therefore, each patient may have a different amount of saline injected.  In general, the injection process is not a painful one, although there may be a sensation of tightness for a day or so following the injection.

The first phase of breast reconstruction using tissue expanders is this stretching of the skin – expansion.  Tissue expansion is very much like pregnancy in that after pregnancy, most women find that they have new skin of their lower abdomen that they did not have before.  The tissue expansion creates new skin for us to work with if necessary. The second stage is replacing the tissue expander with a permanent implant and enhancing the aesthetics of the reconstruction.  During the second stage, minor adjustments will be made in terms of the placement of the implant(s) or of the nipple areolar complexes, if they were kept, or definition of the fold underneath the breast(s).  At the time of the replacement of the tissue expander, I may also liposuction the side of your chest if necessary and usually do some liposuction of your abdomen to fat graft to make your reconstruction look softer and smoother and to hide the surface and contours of your implant.  Breast reconstruction with tissue expanders is always a staged procedure.

If only one breast is being removed, a procedure on the other breast may also be performed at the first or second stage to help give symmetry with the reconstructed breast.  This procedure may be a breast lift, a breast reduction or a breast augmentation depending on the anatomy of the patient.  By federal law, insurance must cover the necessary procedures on both breasts.  Some patients will opt for a double mastectomy, but this is a decision to be made with your breast cancer surgeon.

The advantage of reconstruction with implants is that although this is usually a staged procedure, each stage is relatively short with a fairly brief recovery and less pain than a DIEP flap or latissimus flap. One goal of breast reconstruction in Richmond is to create a breast shape that looks as natural and symmetrical as possible while providing a safe, lasting reconstruction. The first operation takes 45 minutes to an hour per breast, and the second operation is generally less time. Another advantage is that the blood loss for each procedure is relatively small.  Also, there are no additional scars on the body with this operation other than the original mastectomy scar.

The disadvantages of the procedure are that it is usually a staged procedure (two or more operations) and that although the size and shape of your reconstructed breast is not likely to change very much, your normal breast will continue to change size and shape, especially if you gain or lose weight if you choose a unilateral reconstruction.  A reconstructed breast by an implant is never perfectly symmetrical with the normal breast.  However, in a bra, the difference should be unnoticeable, even in the long term.  Therefore, a bilateral implant mastectomy reconstruction often looks better than a unilateral reconstruction.

Radiation and Risk Factors

I need to caution you that radiation therapy, either before or after implant surgery, may cause marked scar tissue formation (encapsulation) around an implant.  It also predisposes you to wound-healing issues, infection and implant loss.  For this reason, an implant may not be the first-choice reconstruction for you if you have already had radiation. If you have had previous irradiation, you are more prone to wound-healing issues and may not have a successful implant reconstruction. If you will need radiation after surgery, there is good evidence that an implant above the muscle will have less pain and deformity than under the muscle, although the skin is more delicate.  This is still a controversial topic.

Statistically, the patients most likely to have complications after reconstruction are significantly overweight, have large breasts which often require complex incisions, have high blood pressure, are diabetic, smoke or have been radiated.

Final Thoughts

Every patient’s experience with breast reconstruction in Richmond is unique. During your consultation, I will review your diagnosis, discuss your reconstructive options, and help you choose the approach that best fits your individual goals and circumstances. I hope this information has not been overwhelming.  I have tried to give you as complete information as possible so that you can make an informed decision.  Nonetheless, I would like to emphasize that most patients are glad they had an implant reconstruction and are quite satisfied with their results.  It will be a pleasure to discuss breast reconstruction with you.  Please do not hesitate to call the office with any questions (804-320-8545).