Implant Reconstruction

Implant based reconstruction can be done at the time of mastectomy (Immediate) or after the mastectomy (Delayed). If the implant base reconstruction is done after a mastectomy, tissue expanders will need to be placed under the mastectomy skin for several weeks prior to placing the implants. If implant reconstruction is done at the same time as the mastectomy, the implants are covered with cadaveric dermis (Acellular Dermal Matrix - ADM) to allow the implants to be positioned directly under the mastectomy skin.

Tissue Expander to Implant Reconstruction

Step One: Expander Placement
The expander is a silicone bag placed below the pectoralis major muscle of the chest at the time of the mastectomy. The expander bag is partially inflated. The procedure is completed by closing the mastectomy defect, and a drain is left under the remaining breast skin.

Step Two: Filling Expander
Approximately two weeks after the placement of the expander, the expander is inflated by placing a needle into the filling port and injecting saline solution. This is done weekly until the expander is 20% larger than the breast on the other side. Some pain and discomfort similar to that of a pulled muscle is felt for a day after each expansion.

Step Three: Waiting
Once the required volume has been reached, the expander is left in place for three months. This allows time for the overlying muscle and skin to stretch. The breast with the expander will look larger and will feel much harder than the opposite breast.  You can expect some level of discomfort during this time period.

Step Four: Exchange
The next operation is done three to six months later.  At this time, the expander is taken out and replaced with a permanent implant – either silicone or saline, whichever is decided on at this time. The final implant is placed below the pectoralis muscle in the “pocket” that was created by the expander in the previous months.

Step Five: Nipple Reconstruction
Final adjustments and nipple reconstruction are done six to eight weeks after the placement of the implant. Nipple reconstruction is done under local anesthesia and only takes 30-45 minutes to complete.  The areola is done by tattooing to make the colour of a nature areola.  Each tattoo can take one hour and may need to be done one or two times to achieve the right colour;

Direct to Implant Reconstruction

Potential Complications with Implant and Expanders

Immediate (less than 1 week)

  • Infection

  • Extrusion- the implant is forced out of position

  • Hematoma- blood collection under the skin

  • Seroma- serum fluid collecting

These complications occur in 1 to 10% of patients and are treated with antibiotics or a minor repeat operation.

 Short-term (1 week to 3 months):

  • Infection

  • Asymmetry of reconstructed breast when compared to other breast

  • Extrusion

  • Capsular contraction- formation of scar tissue around the implant

  • Leakage, or rupture.

These complications may require a surgery to be corrected.

Long-term:

  • Capsular contraction

  • Leakage, rupture,

  • Infection

  • Asymmetry of reconstructed breast when compared to other breast

These complications call for a re-operation in 30% of patients within four years of the initial breast implant reconstruction surgery.