TISSUE EXPANDER TO IMPLANT
Together with your plastic surgeon, you will decide which style of breast reconstruction best suits your individual needs
First and foremost, your surgical oncologist ("breast cancer surgeon") will need to remove all of the cancer in your breast. If you have a mastectomy, all of your breast tissue will be removed. Your breast skin remains. Sometimes your nipple remains, but that decision is made by your surgical oncologist.
After your surgical oncologist takes all of the breast tissue out, the plastic surgeon will begin the process of reconstructing the breast.
After your mastectomy, you and your plastic surgeon may decide on reconstruction with breast implants.
For many women, a permanent implant ("direct to implant" reconstruction) cannot be placed at the time of mastectomy. Instead, a temporary implant, or tissue expander, is placed first. This "water balloon" is placed either above or below your pectoralis major muscle and is held in place inferiorly by a sling of acellular dermal matrix (ADM). Also known as a soft tissue matrix, this graft is made from cadaveric skin that has been processed in a factory to remove all cells. It acts as a support scaffold for your own cells to grow into. ADM has been used in breast reconstruction safely for many years.
After the tissue expander and sling are positioned, the expander is filled with some salt water and the skin is closed. You will have drains that will be placed in the new breast pocket and poke out through the skin. The nurse will teach you how to care for these drains at home, and they will be removed in the doctor's office. Most women stay in the hospital 1 night after surgery to recover before going home.
Once the scar has healed, your tissue expander will be filled with water in the doctor's office each week. This continues until your new breast enlarges to a size that is right for your body. This expansion process can be combined with chemotherapy and radiation therapy.
For most women, approximately 3 months after your first surgery, you will undergo another surgery to remove the water ballon and replace it with a permanent implant. .
PREPECTORAL TISSUE EXPANDER PLACEMENT
Some plastic surgeons have recently changed their technique to wrap the tissue expander in ADM and place it over the pectoralis muscle ("pre-pec" = on top of muscle). Because the muscle has not been elevated, patients often experience less pain after this procedure. While this technique has become more popular in the recent years, there is no long-term study or data that shows this is a better reconstructive option.
In some instances, your expander may initially be inflated with air as opposed to salt water. This may allow faster expansion, or “filling,” of the expander and be less painful during weekly office visits. However, most surgeons do eventually remove the air and refill the expander with water prior to the second stage implant operation.
You and your plastic surgeon will decide which implant type is right for you.
There are two general categories of breast implants: saline and silicone implants.
Saline implants were the only fully approved breast implants in the United States from 1992 - 2006. They are still a popular option for breast reconstruction today.
There were concerns that silicone implants were associated with connective tissue disorders, and they were removed from the market in 1992. Many years of research has shown no association, and in 2006 the Food and Drug Administration (FDA) approved the use of silicone gel implants and they were reintroduced for breast reconstruction.
Many women prefer silicone gel, as they tend to feel more like a natural breast. They are less visible as compared saline implants, and have less risk of scarring around the implant known as capsular contracture.
Both saline and silicone implants come in numerous sizes and profiles. There are smooth and textured designs. You and your plastic surgeon will decide which implant is right for you.
The surgery to exchange your tissue expander to implant is relatively straightforward and is usually done as a same day surgery. Once your implants are placed, you will likely feel more comfortable than you did with the tissue expander.
Additional procedures including the creation of a nipple and areola, fat grafting, and scar revision are usually performed about 3 months after your implant is placed and the scar is healed.
Implant reconstruction is not a great operation for all patients. Talk to your surgeon if:
- you are an active smoker
- you are an uncontrolled diabetic
- you are having or have had radiation to the breast
- you have medical conditions which put you at risk for a long surgery or multiple procedures
All surgeries have risks. Talk to your doctor about the risks associated with each procedure.