Implant Breast Reconstruction
Breast Reconstruction with Silicone Implant
Many options exist for breast reconstruction after mastectomy, and nearly all patients are candidates for some form of breast reconstruction. The decision to reconstruct a breast that has been lost due to breast cancer, the BRCA gene for breast cancer, or damaged by radiation or infection is personal.
Dr. Fisher will listen to your goals and concerns, and will work with your oncologist and your breast cancer surgeon to develop a safe treatment plan that fits your body type and your lifestyle. Dr. Fisher is a skilled reconstructive breast surgeon, adept at both traditional and advanced implant techniques, as well as advanced breast reconstruction techniques that use a woman’s own living tissue to restore the breast.
Many women choose an implant-based route for breast reconstruction. If a patient is a candidate for nipple sparing mastectomy, the mastectomy surgeon removes the gland and duct through an incision hidden along the fold of the breast. For these patients, the nipple can be preserved and an implant can be placed underneath the skin to replace the volume lost.
If the nipples must be removed, three to six months after your initial surgery the nipple will be reconstructed as part of a second touch-up surgery. Three-dimensional areola tattooing is also available in the office to add color to the areola and the appearance of texture to the reconstructed nipple.
For many patients the first step involves placement of a tissue expander, which is a breast-shaped device with an easy-to-access port. This inflatable device is wrapped in a regenerative support scaffold and placed carefully under the mastectomy skin at the time of your initial mastectomy surgery. In some cases this is placed under the pectoralis muscle. When appropriate, Dr Fisher prefers to do a less invasive implant reconstruction in which the implant is placed on top of the pectoralis muscle. This reconstruction can performed with a nipple-sparing mastectomy for an exceptionally natural-looking result.
Depending on the desired size of your new breast, the tissue expander will be expanded weekly at the office by the addition of saline through the port. This will stretch your skin until it can accommodate your desired implant size.
(A) A tissue expander is placed below the pectoralis muscle, the lower edge of which is first surgically separated from the underlying chest wall structures. As the expander is gradually inflated like a balloon—by injection with sterile fluid at regular intervals over a period of a few months—it stretches out the muscle and overlying skin to create enough space to accommodate an implant of the desired size. (B) During a second surgical procedure, the tissue expander is removed and a breast implant is placed in the pocket created below the stretched-out muscle. In many cases, the stretched muscle will cover only the upper portion of the implant. (C) Tissue expansion may be combined with the placement of a tissue matrix such as AlloDerm® to effect more complete coverage of the breast implant. Tissue matrix, attached to the lower edge of the pectoralis muscle and the chest wall, is shown spanning the lower portion of the implant.
Surgery to insert the tissue expander takes about two hours, and Dr. Fisher will inject a long lasting pain blocking medication to reduce postoperative pain. You will spend one night in the hospital. Several surgical drains will be used in the breast and will stay for two weeks.
After three months you will need another procedure to remove the expander and to insert the silicone implant. At this time many patients undergo fat grafting to improve the thickness of the mastectomy skin and to improve aesthetic contour. If desired, nipple reconstruction and/or nipple tattooing can be scheduled two to three months after your implant is in place.
To find out more about implant-based breast reconstruction, or any other breast reconstruction option, call our office to schedule a consultation.