Implant Based Breast Reconstruction
What is Breast Reconstruction?
Breast Reconstruction is commonly performed following mastectomy, in patients diagnosed with breast cancer. The majority of patients who undergo breast reconstruction following mastectomy do so through the use of breast implants. This technique for breast reconstruction has been the preferred procedure used for decades and has remained a reliable option for many. Typically performed in multiple surgeries this method of breast reconstruction can deliver reliable, long lasting results for many patients.
Breast reconstruction is commonly multiple stages, meaning the patient will undergo at least 2 outpatient procedures.
- The first surgery, which is usually performed at the time of mastectomy and coordinated with the breast oncologic surgeon, involves the placement of a tissue expander. This device is similar to a water balloon and allows the surgeon to customize the reconstructive results by expanding the available skin following surgery to the desired size of the patient based on her underlying body type. In the majority of patients, the expander is placed above the pectoralis major muscle and covered with a biologic material known as an acellular dermal matrix. (ADM) The ADM integrates into the body and becomes an extra layer of protection surrounding the implant. Over the next 2-3 months the expander is gradually inflated in the surgeon’s office by placing a needle through the skin and into the device (most patients are numb in the breast skin so this is not typically uncomfortable). Once the desired size, or limit of possible inflation is reached, the expander is left in place for approximately 1 additional month, after which time the patient is ready to have the exchange procedure.
- The second surgery, after the tissue expander is fully expanded, involves removal of the tissue expander and placement of silicone gel implant. The silicone implant is most commonly placed above the patient’s pectoralis major muscle. The exchange procedure for silicone implants is simpler and has minimal recovery as compared to the initial surgery.
- Following the exchange to silicone patients may notice areas of irregularity or imperfection in their reconstructed breast. This is typically a result of attempting to fully reconstruct the body’s tissues using a standard device that will be different from the unique anatomy inherent to each and every person. These imperfections can be improved and possibly eliminated using additional techniques. Fat grafting is an exciting and new technique for attaining this goal and is the preferred procedure used by our surgeon (See fat grafting for more details).
- The first procedure, in combination with the mastectomy, takes on average 3 hours. The patient is usually admitted to the hospital for 1-2 nights for monitoring and pain control. Those admitted for observation and pain control to the hospital will be rounded on daily while inpatient and will then follow up in our office 5-7 days after discharge.
- The second procedure, expander to silicone gel implant exchange, typically takes 1 hour. It is performed on an outpatient basis, meaning the patient will go home the same day. There is minimal recovery as compared to the initial surgery.
- Some patients require additional surgical procedure of fat grafting to improve on irregularities or imperfection following silicone implant place, or in some cases when patients undergo radiation therapy as part of their oncologic treatment plan. This procedure last approximately 1-2 hours and is done outpatient with minimal recovery.
Things to know:
- Patients will have approximately 2 drains in each breast after initial surgery. Inflammation from surgery causes an accumulation of serous fluid that is managed with these drains. You will need to milk and empty these drains, recording the output preferably twice daily and at the same time each day. Drains will remain in place, on average of 2-5 weeks, until output is less than 30ml for an entire 24-hour period. Drains will not be required for second stage, or fat grafting (if necessary).
- Patient will remain on an antibiotic while drains are in place.
- You may begin showering in 48 hours after surgery. When showering, wash all areas with soap and water, and pat dry with a towel. It is important that you do not submerge your surgical incision in water (i.e. no bath tubs, swimming pools, etc.).
- Sutures will be absorbable. Follow up appointments will be scheduled on a weekly basis, to monitor drain output and perform tissue expansions.
Postoperative restrictions are as follows:
No heavy lifting, pushing, or performing any activities that engage the pectoralis muscles for 6 weeks. We will gradually increase the weight you may lift and your activities over the next few weeks. At 8 weeks you are cleared for full activity.