The most common way breasts are reconstructed after mastectomy in the United States.
Most women with breast cancer or at high risk for breast cancer are candidates for prosthetic breast reconstruction after mastectomy.
Absent breast(s) after mastectomy.
2 stage immediate (tissue expander followed by exchange for a breast implant)
A thoughtfully and carefully selected tissue expander is placed into the mastectomy defect. The superior (top) part of the implant is placed under pectoralis major muscle. The inferior (lower) part of the implant is placed under an acellular dermal matrix and the breast skin remaining after the mastectomy is sewn together over the top of everything. The advantages of placing a tissue expander as a first stage include less initial stress on the skin, more control of the future implant pocket location, more control of the future implant size. After a few weeks once the skin has acclimated to having the breast tissue underneath is removed and the incision is partially healed – the tissue expander is accessed with a needle in the clinic and saline is added on a weekly basis until the desired size is achieved. Then we return to the operating room and swap the tissue expander for a saline or silicone breast implant. This second surgery is an outpatient surgery with a much shorter recovery than the first operation.
1 stage immediate (direct to implant at the time of mastectomy)
A thoughtfully and carefully selected silicone or saline breast implant is placed into the mastectomy defect, skipping the tissue expander stage. The superior (top) part of the implant is placed under pectoralis major muscle. The inferior (lower) part of the implant is placed under an acellular dermal matrix and the breast skin remaining after the mastectomy is sewn together over the top of everything.
1 stage delayed
Same as the “1 stage” above except that no device is placed at the time of mastectomy. Instead, the mastectomy is performed and ~2 weeks are allowed to pass while the mastectomy skin acclimates to its reduced blood flow. After a 2-3 week delay, you return to the operating room and breast implants are placed before the skin starts to scar down to the chest wall and contract.
To reconstruct the breast(s) after mastectomy
Patients cannot be using any nicotine-containing substances.
Most patients spend 1 night in the hospital after the first stage (mastectomy).
You will be able to walk around, feed and bathe yourself. Depending on your pain medication requirements, you may not be able to care for others or drive a car.
You are encouraged to walk around the house as much as possible to help reduce the risk of DVT and thromboembolism.
After 48 hours you should remove your dressings and take a shower.
You should do mild/gentle stretching exercises immediately after surgery to prevent your arm and chest muscles from getting tight. Light exercise is okay two weeks after surgery with your new breasts well supported. No arm exercises (other than stretching) for 6 weeks.
Wait 1 week because you don’t want to increase your blood pressure during the early healing period. After 1 week, sex is ok ONLY if your partner is able to resist touching your breasts. You are the only person allowed to touch your breasts for the 6 weeks following surgery.
Depending on your type of work you can resume light office work as soon as you feel you are able to do so. Most people take about 1-2 weeks off work.
Usually, it peaks around 3 days and gradually goes away.
If present should subside within 1-2 weeks.
Inherent Risks & Complications
Hematoma, Seroma, Infection, Device malposition, Device exposure, Capsular contracture, Implant rupture, Poor scarring, Need for revision, complications related to anesthesia.
Performed by: Dr. Butler, Dr. Leveque, Dr. Patterson