Reconstruction with Implants / Expanders
This type of breast reconstruction uses breast implants — silicone devices filled with silicone or salt water (saline) — to reshape your breasts. Primary goal is to recreate the breast contour and volume. The breast reconstruction process begins with the placement of a breast implant or tissue expander, either at the time of your mastectomy surgery (immediate reconstruction) or during a later procedure (delayed reconstruction). Please do keep in mind that breast reconstruction is a multi-step process that many a times involves follow up procedures for small revisions.
If you undergo an expander placement initially, the process in completed in three stages as follows.
Stage 1 – Placement of the Tissue Expander
Stage 1: The first stage involves placement of tissue expanders. This can either be done at the time of the mastectomy (for immediate reconstruction patients) or after the mastectomy has healed (for delayed reconstruction patients). Expanders are essentially temporary implants that act as spacers. Breast reconstruction with implants or tissue expanders, in our practice, is generally reserved for patients who do not have adequate tissue for a flap reconstruction, or do not wish to use their own tissue for reconstruction.
Stage 2 – Expansion of the Tissue Expander
Stage 2: The expanders are filled as much as possible at the time of the initial surgery. Further expansion is performed in the office as required once the incisions have healed. This expansion process can require several weeks, depending on the amount of expansion required by the patient to reach the optimal breast size.
Stage 3 – Replacement of the Tissue Expander with Softer Implant
Stage 3: Once the tissue expanders are adequately filled they are exchanged for permanent breast implants. Two types of breast implants are available to patients: Saline and Silicone. It is advised that you speak with your plastic surgeon as to which implant would be best for you. Patients who undergo breast reconstruction with implants should be aware that their implants may need to be replaced at a future date
Some patients are candidates for Alloderm One-Step Breast Reconstruction whereby a permanent implant is inserted immediately following mastectomy. The patient avoids the use of an expander and the whole expansion process. In the one-step Alloderm reconstruction the breast implant is completely covered by the pectoralis muscle and Alloderm. The choice between direct placement of an implant or a tissue expander initially followed by an implant placement, depends largely on the availability and the quality of the skin and muscle tissue left after the mastectomy.
Nipple is reconstructed at a later stage and finally the area is tattooed to recreate the areola and the nipple pigmentation. Most of the times the revisions, if necessary, are performed at the same time as one of the other surgeries previously mentioned. Similarly, if a separate procedure is required on the other breast to achieve symmetry, it can be performed as an additional stage or can be combined with one of the stages mentioned above.