Breast Reconstruction after Mastectomy with Tissue Expanders/ Breast Implants

Breast reconstruction with tissue expanders and breast implants is the most common type of reconstruction performed after mastectomy. Most patients are candidates for this operation, which can be done in one or two stages, depending on your individual anatomy. When done as a two-staged operation, a temporary spacer called a tissue expander is placed in your breast pocket after the breast tissue is removed by your breast surgeon. The tissue expander looks like a deflated water balloon with a rubber port. The expander is partially filled with saline during the first operation and the incision is then closed with stitches. Over the next few weeks, the tissue expander is slowly inflated at your office visits until your desired size is obtained. Once you reach your desired breast size, you have your second stage surgery which involves removing the tissue expander and replacing it with a permanent saline or silicone gel implant. When done as a one-stage operation, the breast implant is inserted directly into the skin envelope at the time of the mastectomy. You may discuss whether you are a candidate for one stage direct-to-implant reconstruction with your surgeon.

Did You Know…

That the quality of silicone gel implants has improved dramatically since they were first introduced in the 1970s? The implants we use today have a very low rate of leakage or rupture.

Frequently Asked Questions

Am I a candidate for breast implant reconstruction?

If you are a candidate for breast reconstruction, you are most likely a candidate for tissue expander-implant reconstruction. There are some exceptions, such as patients with inflammatory or very aggressive breast cancer, who should not have breast reconstruction. Implant-based reconstruction also has a higher risk of complications for patients who smoke or need radiation.

What can I expect from the breast reconstruction procedure with tissue expanders and implants?

Before surgery, you will be placed under general anesthesia. You will then undergo mastectomy by your breast surgeon followed by immediate placement of the tissue expander or implant by your plastic surgeon. You will have drains in each operated breast. You will stay overnight in the hospital and go home the next day. Most patients complain of chest tightness after this surgery. You will be prescribed muscle relaxants that will help with the tightness.

Will I need to follow any special post-op instructions after receiving implant-based reconstruction?

Your surgeon will discuss specific instructions for this operation. You will need to empty your JP drains 2-3 times per day and record the output. This will let your surgeon know when the drains are ready to be removed. You cannot shower while your drains are in. Your drains will be removed in the office before your tissue expansions are started.
After breast reconstruction, some patients find themselves unsatisfied with the result. This can be due to the nature of the initial mastectomy, early complications such as skin loss, or post-operative treatment such as chemotherapy and radiation. It is sometimes possible to improve the appearance of breast reconstruction with a delayed revision procedure. This can involve removing one type of implant and exchanging for a different type, changing from implant to autologous reconstruction, or adding fat to the area (fat grafting) to fill out hollows and divots. Breast reconstruction revision surgery is extremely complex and requires a great deal of individualized treatment planning. There are many factors that are out of your control when undergoing cancer treatment and breast reconstruction. Discuss your case with your surgeon to determine which option is best for you.

Did you know…

If you are not satisfied with your breast reconstruction results, breast revision surgery may be able to help you obtain more satisfying results? There are various options available to you in terms of breast alterations including changing your implant size or type, or changing the reconstruction type.

Frequently Asked Questions

Am I a candidate for breast revision surgery?

You may be a candidate for breast revision surgery if you have had breast reconstruction in the past and are not currently satisfied with the results.

What can I expect from the breast revision surgery?

Most breast revision surgery is done as an outpatient. Recovery is typically 1-2 weeks depending on the type of surgery.

Will I need to follow any special post-op instructions after breast revision surgery?

Following surgery, your recovery will depend on the type and severity of the procedure. You will experience some tiredness and soreness for the first week or two. Because you are recovering, you will want to follow all post-op instructions and take special care to avoid strenuous activities for the first 2-4 weeks after surgery.
A nipple sparing mastectomy is a new approach to the traditional mastectomy that preserves the breast skin envelope and nipple by only removing the internal glandular tissue. Immediately following the mastectomy, breast reconstruction surgery occurs with the use of a temporary spacer (tissue expander), breast implant, or natural tissue (DIEP flap). Nipple sparing mastectomy is an excellent option for certain patients with early-stage disease or those having preventative mastectomies.

Did you know…

More women are choosing bilateral mastectomies when they are diagnosed with one-sided breast cancer. The non-cancer side can be nipple-sparing even when the nipple has to be taken on the cancer side.

Frequently Asked Questions

Am I a candidate for nipple sparing mastectomy?

You may be a candidate for nipple sparing mastectomy if you have a small tumor far away from the nipple, early stage disease, or you are having prophylactic masetctomy. Your tumor must not involve the nipple or underlying areolar tissue, and it should be surrounded by a clear margin of cancer-free tissue. You may also be a candidate if you have the BRCA gene mutation and are seeking preventative treatment.

What can I expect from the nipple sparing mastectomy procedure?

Before surgery, you will arrive at the hospital and be placed under general anesthesia. During the procedure, and incision will be made typically along the lower outer quadrant of your breast fold. This is the ideal incision as it is nearly invisible from the front and avoids scars on the front of your breast. The glandular tissue will then be removed by the breast cancer surgeon. Once the glandular tissue has been removed, you will receive breast reconstruction through either tissue expander, implant, or autologous methods. After surgery, you will wake in the recovery room and be transferred to a hospital room for your overnight stay.

Will I need to follow any special post-op instructions after my nipple sparing breast reconstruction?

Following surgery, you will experience some tiredness and soreness for the first week or two. Because you are recovering, you will want to follow all post-op instructions and take special care to avoid strenuous activities for the first 2-4 weeks after surgery. You may also need to wear a supportive surgical or sports bra to ensure optimal healing.

Breast Reconstruction after Mastectomy with Autologous Tissue

Autologous breast reconstruction is a type of breast reconstruction that uses tissue from another part of your body to form a breast shape. This tissue can be fat, muscle, and/or skin, and usually comes from the belly, back, buttocks, or inner thighs. At DC Plastic Surgery Boutique, we use two main types of tissue flaps in our breast reconstruction: DIEP flaps and Latissimus flaps.

DIEP Flap

DIEP stands for Deep Inferior Epigastric Perforator, which is the name of the blood vessel that goes to the lower portion of the belly. With a DIEP flap, the fat and skin of the lower belly are transferred to the upper chest to rebuild the breast. We use a microscope and very small sutures to sew the blood vessels from the DIEP flap to the blood vessels in your chest to keep the flap alive in its new location. Using a DIEP flap means that no muscle is used, which results in a faster recovery and a lower risk of developing weakness in the abdominal wall.

Latissimus Flap

A latissimus flap uses the latissimus dorsi muscle, along with the skin and fat of your mid-back to reconstruct the breast. The latissimus dorsi muscle is a broad, flat muscle on your back that you use when doing pull-ups. The latissimus muscle is one of many muscles that supports your shoulder girdle; therefore, it can be removed without any significant functional defecit. The rest of the muscles of your shoulder girldle take its place when it is moved. The flap is lifted from your back and turned under your arm to reconstruct your breast mound. The blood vessels remain intact, meaning that the blood supply for your breast comes from the original location on your back. Latissimus flaps are used in patients who are not good candidates for DIEP flap reconstruction.

Did You Know…

That autologous breast reconstruction has excellent results in the long term? Because it is your own natural tissue, autologous breast reconstruction gains and loses weight with you, ages with you, and continues to look and feel like you throughout your lifetime.

Frequently Asked Questions

Am I a candidate for Autologous Breast Reconstruction?

If you have undergone or will be undergoing a mastectomy, then you may be a candidate for autologous breast reconstruction. The type of autologous breast reconstruction will depend upon your cancer treatment, body habitus, and overall health.

What should I expect during an Autologous Breast Reconstruction procedure?

Before the surgery, your doctor will provide you with guidelines on eating and drinking, adjusting medications, and quitting smoking. The day of the surgery, you will arrive at the hospital and undergo general anesthesia. During the procedure, tissue will be moved from one area of the body to your chest to reconstruct your breast. The type of procedure will determine where and how the tissue is being relocated.

Will I need to follow any special post-op instructions after my autologous breast reconstruction?

After surgery, you will need to take any medications that are prescribed by your doctor. This will help reduce your pain and risk of infection. You may also have drainage tubes to remove excess fluids and these will need to be kept clean, as well as any sutures. Specific instructions will be provided to you depending on the type of surgery.
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