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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, the expander-implant technique, types of breast
implants, chemotherapy and radiation, please select one of the
links below:
Can I have both breast breasts reconstructed
with the expander-implant technique?
Yes, and bilateral reconstruction is a relatively common occurrence.
In this situation better symmetry occurs because both breasts
are reconstructed with the same technique and the inability of
implants to create "droop" in the breast is no longer
relevant.
Can the expander be damaged or leak during
the expansion process?
Yes, although leakage is quite rare. If a leak should occur,
remember it's leaking saline solution which is harmless in small
volumes, and depending upon when the problem occurred, the expander
can either be replaced or implant placement undertaken.
Can I have expansion if I'm undergoing
chemotherapy?
The expander can be inflated while undergoing chemotherapy if
the patient's blood count and general health allows although some
surgeons prefer to modify the expansion schedule. Upon completion
of expansion, and to optimize wound healing, the surgery date
for expander removal and implant placement is carefully chosen
with regard to recuperation and normalization of blood tests after
chemotherapy.
With the recent increased use of chemotherapy for less advanced
disease the question as to whether those undergoing immediate
reconstruction with implants incur an undue risk of complications
with subsequent chemotherapy was addressed in a 1996 study from
the University of Missouri. The authors found no statistical evidence
that patients who undergo immediate reconstruction followed by
chemotherapy were at greater risk for complications or poor outcome
than those patients who did not undergo chemotherapy. (Reference:
Yule, et. al. Is There Liability With Chemotherapy Following Immediate
Breast Reconstruction? Plast. Reconstr. Surg. 97: 969 1996).
Can I have expansion if I'm undergoing
radiation therapy?
Yes, however, we ordinarily do not expand during or after radiation.
If an expander reconstruction is combined with radiation we complete
the expansion quickly, place the permanent implant and then radiate
if the radiation oncologist and medical oncologist approve this
schedule.
The use of tissue expansion and implant reconstruction in irradiated
fields has been associated with failure in up to 40% of cases.
What does a saline breast implant consist
of?
A breast implant is a bag that is surgically placed either to
augment an existing breast or to replace breast tissue that has
been lost or is congenitally missing.
The most popular breast implants in the United States historically
have been filled with either silicone gel or saline (salt water).
Currently, saline breast implants consist of the implant shell,
which is made of silicone elastomer (rubber), plus the saline,
which fills the shell. The silicone elastomer contains the following
substances:
- Small amounts of various smaller silicones;
- Small amounts of metals such as tin and platinum and trace
amounts of other metals;
- Trace amounts of volatile materials such as xylene and other
organic compounds;
- Considerable amounts of finely powdered silica.
At least one manufacturer (Mentor) produces latex free implants.
Anatomical Saline Implants |
Round Saline Implants |
Does radiation harm implants?
Although there are some published reports to the contrary a committee
of the prestigious Institute of Medicine (part of the National
Academy of Sciences) found "no significant evidence that
implants interfere with radiation therapy." Implants do not
appear to interfere with radiation beams; however, there is a
concern that radiation can lead to capsular contracture.
What happens after I've finished tissue expansion?
At the end of the expansion process, with an adequate amount
of skin stretching to accommodate the desired implant, the final
breast implant is placed, usually below the pectoralis muscle.
The placement is done as a surgical procedure at which time the
expander is removed and discarded.
Often, at this same time, the level of the inframammary fold
is adjusted to provide a better match to the contralateral (other)
breast and frequently a modification of the contralateral breast
is also performed.
The choice of inpatient or outpatient surgery depends upon the
scope of this second procedure, but more than a single night's
hospital stay is rare.
What types of implants are available today?
Most reconstructions today utilize saline-filled implants. These
implants are filled with salt water and the FDA believes that
saline-filled implants are safer than gel filled implants. Silicone
gel filled implants are actually still available but only for
women who are enrolled in an FDA approved clinical study. Women
who have undergone breast cancer surgery are eligible to enroll
in a study and women who have undergone cosmetic augmentation
are eligible if they are not satisfied with their saline implants
because of rippling or firmness.
Breast implants are manufactured in a wide variety of sizes and
shapes and custom sizes and shapes are available if needed. In
our practice we use primarily round implants for cosmetic breast
augmentation and the "anatomical" (or "tear-drop"
type) for breast reconstruction. I believe that the anatomical
implants provide a more natural shape to the reconstructed breast
and these are available in several different styles with varying
height, width and projection. There is evidence that the anatomical
implants do not provide an advantage for women undergoing cosmetic
breast augmentation.
Today's saline-based implants are available with both textured
and smooth shells, although the anatomical types are available
only with textured shells.
One possible disadvantage of textured implants is that the folding
and wrinkling associated with the implant is more likely to be
transmitted to the overlying skin by adhering to the adjacent
tissue in a "velcro®" like fashion. This potential
disadvantage may be outweighed by the advantages of texturing
although the wrinkling can be an important issue for some patients.
Anatomical Saline Implants |
Round Saline Implants |
Silicone Gel
Implants |
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Reconstruction Index
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454-0044.
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