RECONSTRUCTION WITH IMPLANTS
The most common method of breast reconstruction is with implants. Synthetic implants are teardrop-shaped pouches that are inserted under the skin to create the form of a breast. The impant is made of silicone, and is filled with saline (salt water solution) or with silicone gel.
There has been a lot of controversy about silicone-filled implants. After extensive studies, most surgeons and oncologists are satisfied that today’s silicone implants are safe.
Before your mastectomy, you will meet with a plastic surgeon to choose an implant that will match your other breast and provide a pleasing, symmetrical appearance. You may want to clip pictures of women’s breasts to bring to the meeting for modeling purposes.
If you’re having immediate reconstruction, the plastic surgeon will take over right after the mastectomy, while you’re still under anesthesia. This part of the surgery will take about an hour.
In order to achieve the most pleasant shape and feel for the reconstructed breast, the implant is usually placed under the muscle, rather than directly under the skin. Sometimes a patch made of biological material is used to reinforce the muscle and provide better coverage of the implant.
If the implant is small, and sufficient skin from the breast remains in place, the surgeon may be able to insert the implant without undue stretch to the skin and muscles of your chest wall. Your reconstruction will be complete.
However, if the implant is too large, the surgeon will need to use a temporary expander.
The expander is an elastic bag equipped with a fill tube and a valve. After the expander is inserted in place, it is filled with a small amount of saline. You’ll return to the surgeon’s office every week or two to have more saline injected into the expander. Gradually, over three to six months, the skin and muscle will stretch, just like they do over the abdomen during pregnancy.
In the second stage procedure, the expander is removed. The existing pocket, or the choice of implant, can be adjusted if necessary. Then the permanent implant is inserted. A nipple and areola can be created during a future procedure.
If you had a skin sparing mastectomy, your natural skin will provide the perfect pocket into which an implant can be placed.
You may also need additional surgery, such as a reduction, or a breast lift, on the other breast, to achieve the best symmetry possible.
The first 24 to 72 hours after your initial implant surgery is when you experience the most discomfort. Your breast will be swollen and tender. Although every woman’s recovery time is different, you should be able to resume many of your regular activities after about one week. You will need to wait at least one month before doing anything strenuous.
During the several weeks required to fully inflate the expander, you will probably have a feeling of fullness in your breast, but no major discomfort.
Over months, scar tissue forms around the implant, creating a tissue capsule. Most of the time, tissue capsules are soft and feel natural. However, in 15% of the cases, the capsule turns into a hard scar that distorts the breast, giving it the consistency of an orange or apple. The surgeon can break up the scar tissue or replace the implant.
If your breast is treated with radiation therapy, the risk of scar tissue and hardening increases.
Most implants that have been in place for 10–15 years have some leakage. The body will react to the leak by forming a protective cyst around the leak. An MRI scan can spot even small amounts of leakage. If the leak leads to significant breast shrinkage, or change in shape, the implant will need to be replaced.