There are two general techniques plastic surgeons utilize for breast reconstruction; one technique may use a synthetic implant, while another may use the patient’s own tissue.
1. Use of implants
The implant is placed in a pocket that is made between the chest muscle (pectoralis major) and the rib. The cut (incision) to make the pocket is done through the scar from the mastectomy. The muscle and skin are closed and allowed to heal for 2- 3 weeks. Implant based reconstruction can be done in a single stage (one surgery under a general anesthetic) or in two stages (two surgeries under a general anesthetic).
2. Use of patient’s own skin, fat and sometimes muscle (autologous tissue)
This reconstruction surgery uses only your own body tissues to help build a new breast. Tissues from the tummy area (abdomen) are often used in this surgery. There is usually extra skin and fat in this area that can be used
When breast implants are used, a saline or silicone gel implant is placed and the new breast shape is molded around it. Surgery may require several stages and the use of a tissue expander, especially when the chest wall tissues are tight and/or flat. Secondary procedures to create nipple areola have to be done as a separate procedure.
Radiation is especially problematic for women who undergo implant reconstructions, regardless of whether the radiation is administered before or after the implant is placed. Some of the complications that occur at higher rates in patients who receive with radiation with implants include wound breakdown, delayed healing, infection, breast implant or tissue expander extrusion, and severe capsular contracture.
In majority, the implant will not last forever. Some implants will need to be changed at 5 years and some at 25 years. If an implant exchange or revision is required, the scar around the implant and the implant is removed and a new implant is inserted.
Because of the potential complications and revisions associated with implants, breast reconstruction using natural tissue is generally considered the best method for women who will require or have already had radiation.
Facts at a glance