Breast Implant Reconstruction
What is Implant Reconstruction?
Breast implant reconstruction refers to breast implant surgery needed for a medically approved reason. This may be for breast cancer, genetic syndromes, or congenital breast malformation. Dr. Lee specializes in breast reconstruction which forms a core part of her practice.
Who Can Have Breast Implant Reconstruction?
Breast implant surgery is meant to improve the quality of life following a medical diagnosis. A physician referral is needed for breast implant reconstruction. Reasons for breast implant reconstruction include:
Breast cancer reconstruction of a partial or complete mastectomy
Prophylactic mastectomy reconstruction, BRCA1 or BRCA2 gene carrier
Balancing surgery after cancer
Tuberous breast deformity
Congenital absence of breast tissue
Patients must be in good general health, enough to safely undergo general anesthesia.
Breast Cancer Implant Reconstruction
Dr. Lee is a specialist in breast cancer reconstruction and has extensive experience with the breast cancer surgical pathway. This must be a team approach with the first goal to cure cancer. There are many ways this can be approached and the treatment plan is customized to your particular care. Breast implant surgery is the most common choice for breast cancer reconstruction.
No additional scars needed – the implant is placed using the same scar as the mastectomy
Can be performed at most hospitals
Minimal surgical time added to the mastectomy (1-2 hours)
Minimal to no overnight stay in the hospital needed
Foreign material is implanted in the body
Implants do not last forever – they are devices usually needing repair or replacement within 10-15 years
Scar tissue reaction and changes can occur over time
The implant breast does not fall like a natural breast and is similar to a breast shape in a bra
Size does not change with weight gains or losses
When Can You Start Breast Implant Reconstruction?
Breast cancer reconstruction can start at the same time as the mastectomy (“Immediate”) or start after the mastectomy as a separate surgery (“Delayed”).
IMMEDIATE RECONSTRUCTION: Starts at the same time as the mastectomy but does not necessarily mean you
have an “instant breast” when you wake up.
Reconstruction starts at the same time as the mastectomy, saving yourself from an additional surgery later
The breast skin or nipple can be “saved” for a more aesthetic result
Cancer status is not confirmed and more treatment (radiotherapy or chemotherapy) may be needed
The addition of extra time and surgical complexity may increase complications. Wound complications may delay the next steps in cancer treatment
In some cases, the size may be limited by the amount and quality of skin present
DELAYED RECONSTRUCTION: Starts after the cancer had been removed and cancer treatment has been performed.
Cancer has been treated fully
The decision is not time-sensitive and can occur at your convenience
There is more size flexibility as the tissues have time to stretch to the goal shape
This requires 2-stages done in 2 separate additional surgeries
Your choice of reconstruction may be limited if you had radiotherapy (results are not ideal for implant reconstruction)
How Are Implants Placed?
Traditionally, breast implant reconstruction happens in 2 stages:
STAGE 1: TISSUE EXPANSION:
After a mastectomy, there is a thin layer of breast skin left covering the chest muscles. An inflatable balloon called a “tissue expander” is placed underneath the muscle to expand this pocket to fit an implant. The expander is inflated with saline solution until the goal size has been reached. Once the skin and muscle has been stretched fully, the expander feels firm. This is now ready to be exchanged with the permanent implant.
STAGE 2: IMPLANT EXCHANGE:
A second surgery is performed to exchange the tissue expander for the permanent implant. The firm/hard tissue expander is removed through the same scar and replaced with the softer and more natural feeling implant. No heavy or cardiovascular exercise is recommended.
In select circumstances, an implant can be placed directly at the time of surgery (direct-to-implant reconstruction), or in front of the muscle (pre-pectoral implant reconstruction). These options will be discussed at your consultation appointment as the conditions for these techniques are limited.
How Are The Implants Selected?
Breast implant surgery involves the placement of smooth, round implants underneath the breast tissue. Implants are made of a thick silicone shell with either a saline or silicone gel fill. There are pros and cons to each.
More natural feeling, softer, less rippling
Ruptures difficult to detect and need and MRI.
Silicone gel stays in the breast.
Salt water filling which is naturally found in the body,
easily cleared away with ruptures.
Increased skin rippling appearance and “sloshing”
feeling because the tissues are thin.
Ruptures have an obvious size change.
The selection of the size depends on your goal size and your body’s natural chest width. Generally for a mastectomy reconstruction, a more full or highly projecting implant will be selected to make up the breast volume lost during the mastectomy.
The usual recovery time is 1 month after surgery. You will have dressings in place to cover the breast. There will be temporary tubes that drain the extra fluid buildup in the implant pocket. Your surgeon will arrange home care nursing to help with dressing and drain care. You will also be given pain medication and antibiotics medications during the recovery period. In the first few weeks you will be closely followed by your surgeon to monitor for signs of infection or wound healing problems.
To keep the implants in the ideal position, we recommend no upper body exercising for 6 weeks, and to wear a surgical bra. You will be provided with detailed information on activities during this recovery time. Clear communication as a part of the cancer care team is important to Dr. Lee. During this time Dr. Lee will communicate with the team to adjust your care as updates and changes may occur.
One year after surgery, your breast implants are stable. You will need to monitor the implant for changes over time. Dr. Lee offers a unique annual implant surveillance program, included for all patients who have received implants at the Ottawa Institute of Plastic Surgery.