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Breast reconstruction plastic surgery
To get answers to the most frequent questions about breast reconstruction
plastic surgery, the implant and expander method, and capsular
contracture, please select one of the links below:
What complications can occur with the implant
and expander method?
As with any surgical procedure there is always a risk of bleeding,
infection and other complications; however, there is minimal risk
of a textured implant "shifting" or moving out of position.
The most common problem experienced following reconstruction
with implants is capsular contracture. According
to data submitted to the FDA in 2000, the one-year risk of capsular
contracture is approximately 11% and 22% at three years.
The most common complications of the tissue expansion process
are infection, problems with the wound and mechanical complications
associated with the expander itself.
Will I need antibiotics from time to time if
I have an implant?
To prevent infection secondary to bacterial seeding of the implant
we recommend antibiotic prophylaxis for every invasive procedure
(i.e. dental cleanings, podiatry visits, etc.).
What is "capsular contracture"?
Capsular contracture is the tendency for a breast
implant to become hard and occasionally painful over time.
The body forms a membrane called a "capsule" around
a breast implant and this capsule contains cells that are similar
to muscle cells. In some cases these muscle like cells contract
seeking the smallest surface area for a given volume, thus making
the implant more spherical and firmer to the touch.
All implants have a capsule but not all have a capsular contracture.
Usually only the two most severe grades of contracture are of
concern.
Can I still have a reconstruction with an implant
if I've had radiation?
Because of the effects of radiation therapy upon the skin's microcirculation,
the risks of wound healing problems and capsular contracture are
significantly increased following radiation therapy.
Although reconstruction with the expander-implant method is not
impossible, many plastic surgeons, our practice included, feel
that another technique of reconstruction should be used in this
situation. This view, however, remains the subject of some debate
among plastic surgeons, and at least one published experience
favors delayed reconstruction with prostheses in properly selected
irradiated patients. (Reference: Parsa, F. D., Breast Reconstruction
with Myocutaneous Flaps in Previously Irradiated Patients Plast.
Reconstr. Surg. 97: 1086 1996, and Kroll, S.S., et. al. Reply.
Plast. Reconstr. Surg. 97: 1087 1996).
What are the advantages and disadvantages of
the implant expander method of reconstruction?
In our opinion the greatest advantages have proven to be the
simplicity and safety of the technique. The surgical procedures
necessary for expander and implant placement are brief, relatively
simple to perform, generate little or no additional scarring and
do not rely upon flaps where blood supply can become problematic.
In the rare situation where a woman decides that reconstruction
is not for her, the expander or implant can be removed under local
anesthesia as an outpatient or even an office-based procedure.
The disadvantages are essentially the inherent limitations of
reconstructive breast implants which include capsular contracture,
implant visibility, wrinkling of the implant, and inability to
create a natural droop to the reconstructed breast. There are
also women who are opposed to implant use because of concerns
regarding their safety.
Moreover, the reconstructed breast will never have the same feel
to touch and cannot match the other breast's "bounce"
while running or jumping. It also will not have the same compliance
in a bra as a normal breast making it necessary to modify bra
style and size. The stiffness of the reconstructed breast makes
the correct placement of the inframammary fold by the surgeon
crucial for a good result and sometimes even requires the surgeon
to choose a slightly smaller size than the opposite breast to
achieve symmetry in a bra.
What will the scars look like?
As in all plastic surgical procedures, the exact appearance of
the scar is at least 50% dependent upon patient related factors
such as genetics, skin coloration, texture, elasticity and thickness.
By utilizing specialized techniques of wound closure, plastic
surgeons endeavor to optimize the aesthetic and functional result
of all scars. The exact appearance of any scar is, however, unpredictable.
Often, in the expander-implant method the surgeon utilizes the
previous mastectomy scar for access during reconstruction allowing
the surgeon to revise and refine the scar with each operative
procedure.
Will blood transfusions be necessary with
this type of reconstruction?
Blood transfusions are almost never needed with any of the procedures
that comprise the implant and expander method of breast reconstruction.
If blood transfusions are administered in an immediate reconstruction,
it is likely to have been needed because of blood loss from the
mastectomy, not the reconstruction.
Where can I get more information on breast
implants?
The FDA has recently produced a new booklet for women considering
breast implant surgery at http://www.fda.gov/cdrh/breastimplants/
which we highly recommend you read.
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To contact Connecticut plastic surgeon Dr. Joseph B. O'Connell about any cosmetic surgery procedures, please fill out
our contact form or call us at (203)
454-0044.
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