Breast Reconstruction with Expanders and/or Implants
Most implant reconstruction involves use of temporary saline implants called tissue expanders that are used to gradually stretch the chest skin and muscle to make room for a fixed-sized implant. Similar expanders are commonly used by plastic surgeons to rebuild damaged facial features and replace tissue damaged or burned.
Empty expanders are placed under the pectoral muscle, and inflated with a small amount of saline. This pushes the muscle forward and creates a little bulge. Over several weeks, this "starter" breast grows as more saline is gradually introduced into the expander during visits to the surgeon's office. The chest muscle and breast skin stretch to accommodate each new infusion of saline, thus creating an increasingly bigger pocket behind the muscle.
Most women complete the expansion process in six to eight weeks. Your own interval may be shorter or longer, depending on how much your skin must stretch to accommodate your implant and how well you tolerate the process.
Once the expanders are filled to the desired volume, they are allowed to "settle" for several weeks. Then, in a brief operation, they are replaced with fixed-size breast implants.
Do-it-yourself expanders (sort of)
A new type of expander gives patients more control over their own expansion.
With FDA-approved AeroForm expanders (manufactured and marketed by AirXpanders), women use a wireless remote control to release up to 30cc of carbon dioxide per day (3 doses of 10cc each) into their exanders. They control when, where and how much they expand their breasts, while eliminating doctor visits for saline fills. (Your surgeon may want to see you once or twice during the expansion process to make sure you're progressing adequately without problems.)
During clinical trials, women completed AeroForm expansion on average in 17 days, compared to several weeks with the traditional method of surgeon-filled expanders. The expansion timeline depends on the condition of your breast skin and how often you trigger a release of carbon dioxide. In a clinical trial, tissue expansion with the AeroForm for all sizes took an average of 21 days as compared to 46 days for saline expanders.
Advantages of implant reconstruction
According to the American Society of Plastic Surgeons, 80% of breast reconstruction involves implants; 94% of implant reconstruction involves silicone devices
Implants are a good reconstructive choice for many women, and they may be right for you too. Before you decide, understand their benefits and limitations. Ask your plastic surgeon to show you samples of both saline and silicone implants, so you can touch them and compare how they feel. Talk to other women who have had implant reconstruction.
Contemporary implants are either saline (salt water) or silicone gel; both are contained in a silicone shell. Saline implants are placed empty into the chest and then filled; silicone implants are pre-filled by the manufacturer. Silicone gel implants are used more frequently than their saline counterparts, primarily because they have a resilience and bounce that more closely mimics the feel of natural breast tissue.
Your surgeon will choose the model that will best fit your chest, but it is always a good idea to discuss your implant options before your reconstruction surgery.
Breast implants, like all man-made devices, tend to wear out and don't last forever (replacement requires anesthesia and takes an hour or so for each breast). They sometimes leak or rupture, although newer generations of implants are thought to minimize these problems. The most common problem with breast implants is capsular contracture, a condition that develops when the natural scar tissue that forms around the implant hardens. In some cases, this might not be problematic or even noticeable, but it can become painful and distort the shape of the new breast. When this occurs, the implants must be removed and either replaced with new implants or a tissue flap; a flat chest without reconstruction is also an option.
While virtually all studies have failed to link silicone implants to serious diseases, concerns remain over how often implants rupture and what happens when and if silicone migrates beyond the breast. The FDA recommends an MRI three years after placement of silicone implants and every two years thereafter to determine whether a "silent" rupture has occurred. Unlike saline implants, which noticeably deflate when they rupture (the saline is harmlessly absorbed by the body), the rupture of a silicone implant may not be apparent.
Used since the 1960s, breast implants now account for 80% of all breast reconstruction procedures. Compared to natural tissue flap procedures, implant surgery is shorter, requires less surgical skill, and leaves fewer scars. Recovery is less intense and quicker, but the entire reconstructive process can take longer to complete.
If you're having a nipple-sparing mastectomy and you prefer implant reconstruction, you may be able to complete your entire reconstruction in a single trip to the operating room.
Many surgeons now perform direct-to-implant ("one-step") reconstruction by using an acellular dermal matrix (ADM)--donor tissue from which the cellular structure has been removed, leaving primarily collagen--to streamline the reconstructive process. Stitching patches of an ADM to the edges of the pectoral muscle or along the inframammary fold (the crease beneath the breast) creates an instant pocket for an implant (see image below, left), eliminating the need for expansion. Some women need a secondary procedure to correct problems or improve cosmetic result.
Direct-to-implant reconstruction offers distinct benefits over traditional implant reconstruction:
Although plastic surgeons increasingly offer direct-to-implant reconstruction, most still prefer traditional implant reconstruction with expansion. (Slower expansion is a more conservative and safe reconstructive method for some women, including those who have healing problems, very thin breast skin, and those with breast tissue that has previously been irradiated.)
Some surgeons use an ADM to support traditional expansion. And more frequently, using an ADM allows surgeons to place breast implants over the muscle, providing a cushioning layer between the implant and the breast skin, and thus avoiding the necessity of cutting the muscle and expanding the pocket beneath to accomodate an implant.
So when consulting with a surgeon who reconstructs with an ADM, be sure to clarify whether he/she performs direct-to-implant or traditional reconstruction with expansion.
creates an instant pocket,
eliminating the need for
expansion. (image: LifeCell)