Understanding implant-based breast reconstruction

After undergoing a life-saving mastectomy, a breast reconstruction using implants can help patients regain a sense of normalcy and restore their self-confidence, as detailed by consultant oncoplastic and breast surgeon Miss Monika Kaushik in this article.

 

 

What are the indications of breast reconstruction surgery?

A mastectomy is a procedure that removes all breast tissue in order to halt the growth and spread of breast cancer. After the procedure, the chest will be flat, and depending on the need for it, the nipples may be removed as well (though in some cases they can be spared).

A reconstruction of the breast can happen concurrently with the mastectomy (called a one-stage operation), or it can be done at a later date, months or even years in the future (two-stage operation) – this may be necessary if the patient is to still undergo cancer treatments like chemotherapy or radiotherapy after their mastectomy.

 

What are the types of breast reconstructions?

There are many different approaches to reconstructing the breasts after a mastectomy, and the best one for the patient will depend on their treatment plan, their desired appearance, and what is recommended based on their condition. Breast reconstructions fall into one of two types:

• Flap reconstruction, where tissue is harvested from elsewhere on the body to make the new breast.
• Implant reconstruction, where a synthetic prosthesis is placed under the skin and muscle to form the shape of the breast.

Implant-based breast reconstruction may be the right avenue for patients who have enough skin to cover and support a breast implant, want minimal scarring from the procedure, and desire a shorter hospital stay with a quicker recovery.

 

What happens during implant-based breast construction?

Breast implants are very varied in size, shape, profile, and texture. Typically, they are made of silicone gel; saline filling used to be very common, but they are more susceptible to punctures and deflation, and they look and feel less natural than silicone implants.

To place the implant, the process begins during the mastectomy. In a one-stage reconstruction, it can be placed immediately, but in a two-stage reconstruction, upon the removal of the biological breast tissue, a tissue expander is inserted in the cavity to help keep the space for the implant at a later date. After the surgery, the patient returns to the clinic regularly for a few months so that the surgeon can incrementally expand the cavity with air or saline solution until it is the appropriate size to match the remaining breast or the patient’s goal. At that point, the patient goes back for the second surgery of the process, where the tissue expander is removed and the implant is inserted.

 

What happens after implant-based breast construction?

There will be scarring, but expert surgeons can disguise them in the natural contours of the body or along the preexisting mastectomy scar. The entire recovery period is expected to be around two months. If tissue expanders are used, they will be removed and replaced with the implant in the second surgery, usually two to six months after the first.

Breast implants are durable, but they are not likely to last the patient’s entire lifetime. It is common for patients to have revisions to adjust or improve the implant. As it is a nonbiological object, the body may come to reject it, and the longer the patient has an implant, the greater the risk of a complication occurring like a rupture, breast implant illness, or even the development of lymphoma.