In the appropriate patient, breast implants provide another option for reconstruction in women following mastectomy. The ideally suited patient is a woman who is undergoing bilateral (both sides) mastectomy who will not require radiation therapy for her breast cancer treatment. Women who have radiation therapy are not considered good candidates for implant-only reconstruction, as the risks of infection and capsular contracture, are unacceptably high. It is very difficult to match a breast reconstructed with an implant to a natural, non-augmented breast.
Most patients who undergo implant reconstruction will require a tissue expander, or temporary implant, that is used to stretch the skin prior to placement of the final implants. The tissue expander is placed under the Pectoralis major muscle in a fashion similar to that used for women who have cosmetic breast implants. During subsequent office visits additional fluid is added to the expanders until they reach the desired volume. At a second procedure the expanders are exchanged for the more permanent implants. Once these implants have settled, nipple and areolar reconstruction can be performed.
Unlike the patient who is choosing to augment a native breast, women having post-mastectomy reconstruction do not have natural breast tissue to cover the implants. This leads to greater visibility of the implants beneath the skin as well as a less natural feel to the reconstructed breast.
The advantage of implant reconstruction is the ready availability of implants in patients who may not have sufficient donor tissue of the abdomen or buttocks area, the ability to match the breasts in women seeking bilateral reconstruction, and the fact that no other areas of the body are affected reducing recovery time.
Implant based reconstruction can be performed at the time of mastectomy (immediate reconstruction) or in a delayed fashion after other cancer therapy is completed. Operative time is approximately 1 hour & the procedure may be done in an outpatient setting.
