This type of reconstruction involves placement of a breast implant to recreate the breast. In most cases this involves placement of a temporary implant, or tissue expander, after the mastectomy. This tissue expander is placed under the skin and muscles of the chest and is then filled over the course of several weeks. Once the desired size is achieved another operation is then performed to remove the tissue expander and place a permanent implant. At this time a saline or silicone implant can be used for reconstruction. We currently offer the highly cohesive, form-stable implant (know as the "gummy bear" implant) which potentially lowers the risks of implant leakage.
In select cases, implant reconstruction can performed in one single operation including the mastectomy and implant. In these cases, additional biologic mesh (called acellular dermal matrix) is used to support the lower half of the implant. In select patients, the nipple can be saved during this reconstruction.
The advantage of an implant reconstruction is that it is a shorter operation with a faster recovery. For this reason it is a good choice for patients who may not be able to tolerate a long operation. It is also a good choice for patients with insufficient tissue to create a breast.
There are some risks involved with implant reconstruction. These include leakage, capsular contracture, infection, asymmetry, rippling, and visibility of the implant.
An implant has a very small chance of leakage. This risk increases over time. If there is leakage of a saline implant, the saline is reabsorbed harmlessly by the body and the breast may become visibly smaller. If a silicone implant develops leakage then further studies may be needed to delineate this. In either case, replacement of the implant will be necessary.
An implant may develop tightening or capsular contracture. When an implant is placed, the body forms scar tissue around the implant. Normally this scar tissue is soft and pliable, but over time it may develop tightening called capsular contracture. This will affect the appearance of the implant and can cause the reconstructed breast to be hard and painful. The risk of capsular contracture is significantly increased in patients treated with radiation therapy and can be as high as 40%. Daily massage may reduce the chance of developing a hard capsule.