Reconstruction using breast implants

Implant reconstruction using breast implants can be performed for both delayed breast reconstruction or immediate breast reconstruction. Delayed breast reconstruction requires that the breast skin be stretched and this means that the reconstruction must be performed in 2 surgeries (see below). Immediate breast reconstruction can also be performed in 2 surgeries but more recently techniques have evolved to allow the reconstruction to be completed in one surgery.

Implant reconstruction in 2 steps

This is the most traditional way of reconstructing a breast using implants. In the first surgery, a water balloon called a tissue expander is placed under the pectorals major muscle in the breast. In the months following the first surgery, the water balloon is filled (expanded) to the desired size. Following a 3-6 months rest period which allows the stretched skin to relax, the water balloon is removed and replaced with a breast implant.

breast recon tissue expander

Good candidates for a 2 step implant reconstruction

  • Delayed or immediate reconstruction
  • No radiation (relative contraindication)
  • Not obese
  • Do not have or want an extremely large breast
  • May consider augmentation of the other breast for symmetry of shape (see balancing procedures)

Recovery for a 2 step implant reconstruction consists of a 2-3 week recovery following the first surgery (overnight stay) and a shorter recovery for the 2nd surgery (day surgery). Drains are used in both surgeries. Fat grafting is often added to the 2nd surgery to improve the overall look and feel of the implant. Nipple reconstruction is performed 2-3 months after the 2nd surgery under local anesthetic (freezing).

 

Implant reconstruction in 1 step (immediate reconstruction only)

Although the traditional 2 step reconstruction can be performed immediately following mastectomy, a newer technique
called direct to implant reconstruction allows a final implant to be placed instead of a tissue expander at the time of the 1st surgery. This avoids the need of a second surgery. Instead of stretching the muscle and skin (as with a 2 step reconstruction), a piece of artificial skin (called an acellular dermal matrix) is connected to the pectoralis major muscle and is used to cover the implant.

implantdermal matrixdirect to implant.

Good candidates for a direct to implant reconstruction

  • Up to a small C cup breast
  • Do not want to increase the size of their breasts
  • Non smokers
  • Patients undergoing prophylactic mastectomy (BRCA 1 or 2)
  • Patients who will most likely not need radiation

Recovery from a direct to implant reconstruction can be up to 4 weeks. One night is spent in hospital and you are discharged home with 2 drains in the breast. Additional procedures can be performed at a later date such as fat grafting and nipple reconstruction (freezing only).

 

For more information on implant reconstruction

Contact us to book an appointment to discuss your breast reconstruction options with Dr. Perry.