Prosthetic Breast Reconstruction Overview
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.
Guide To Breast Augmentation
Guide To Breast Procedures
What I Wish I Knew
Facts About Prosthetic Breast Reconstruction
Typical Timing/Age
Most women with breast cancer or at high risk for breast cancer are candidates for prosthetic breast reconstruction after mastectomy.
Cost
Insurance covers this procedure.
Goal
To reconstruct the breast(s) after mastectomy
Assistance
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.
Walking
You are encouraged to walk around the house as much as possible to help reduce the risk of DVT and thromboembolism.
Exercise
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.
Work
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.
Inherent Risks & Complications
Hematoma, Seroma, Infection, Device malposition, Device exposure, Capsular contracture, Implant rupture, Poor scarring, Need for revision, complications related to anesthesia.
Problem
Absent breast(s) after mastectomy.
Facility
Hospital
Preparation
Patients cannot be using any nicotine-containing substances.
Anesthesia
General anesthesia.
Hospital stay
Most patients spend 1 night in the hospital after the first stage (mastectomy).
Showering
After 48 hours you should remove your dressings and take a shower.
Sex
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.
Swelling
Usually, it peaks around 3 days and gradually goes away.
Bruising
If present should subside within 1-2 weeks.
Related Procedures
Breast Reconstruction
Latissimus Flap Breast Reconstruction
Pedicled TRAM Flap Breast Reconstruction
Oncoplastic Breast Reduction
Before & After Gallery
Procedures are performed by board-certified by the American Board of Plastic Surgeons, Dr. Butler, Dr. Leveque, and Dr. Patterson in Pensacola, FL.
Meet Our Team
At Gulf Coast Plastic Surgery, we understand that the selection of a plastic surgeon is an extremely important decision for any prospective patient. We believe communication, education and individualized patient care are the foundation for creating a strong and trusting patient-physician relationship. Our entire staff is absolutely committed to providing compassionate, personalized, individual attention before, during, and after surgery. We work together to deliver the best possible aesthetic outcomes in a setting that embodies the standards and lifestyle you seek.
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