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Breast Reconstruction

What is Breast Reconstruction

Breast reconstruction with tissue expander placement – (ex. after mastectomy). This is essentially a pouch that can be expanded by the injection of saline through a self-sealing fill port in order to create the amount of tissue needed to reconstruct an area with defect. Staged breast reconstruction begins with a tissue expander at the time of mastectomy, followed by placement of the final implant at a second stage. This two-stage approach is currently the most common method of implant breast reconstruction. The alternative is immediate placement of the implant at the time of mastectomy, a single-stage procedure that can only be done for patients that meet specific criteria. If you require mastectomy and are considering implant-based reconstruction, Dr.Karatzias can help you decide which of these approaches is best for you.

Tissue expander implant breast reconstruction requires a staged approach. To begin the process, the tissue expander is first placed on the chest wall in a pocket created deep to the pectoralis muscle. This first stage can be performed immediately after mastectomy or at a later point in time as a delayed procedure. The tissue expander itself is essentially a pouch that can be expanded by the injection of saline through a self-sealing fill port. When initially placed, the expander is partially filled with saline, potentially providing an immediate breast contour. At intervals that usually range from one to three weeks, the expander is then slowly filled through additional saline injections. For the purpose of expansion, the fill port on the front of the expander can be accessed through the skin during a simple office procedure. If needed, expansion sessions can be coordinated with chemotherapy treatment. At a typical expansion, a volume of 50 cubic centimeters of saline (approximately 10 teaspoons) is injected through the port to fill the tissue expander. Because of the incremental nature of the expansion process, most patients have minimal pain or only mild discomfort associated with the expansion procedure.

The number of expansions required depends on how much fluid was placed at the time of expander placement as well as on the quality of the surrounding soft tissue. Once the desired volume is achieved, the second stage of reconstruction can be planned. The second stage of expander-implant breast reconstruction is an outpatient procedure, which involves replacement of the tissue expander with a breast implant.

Which silicon implant is right for me?

Silicone implants come in various sizes and shapes, and are available with either a smooth or textured shell. Once the expansion process is complete, the proper implant can be chosen, taking into consideration factors such as patient preference, chest wall measurements and the quality of healed soft tissue at the mastectomy site. The exchange can then take place as an ambulatory surgical procedure. Patients often report feeling immediately more comfortable upon removal of the expander and placement of the final implant. The breast implant should fit nicely within the pocket that has been formed, and any tightness or discomfort should continue to decrease as the implant settles and the scars heal. After a period of two or three months, the third stage of the breast reconstruction can then be completed allowing reconstruction of the nipple areola, and if needed, any other revision procedures.

Are there any risks?

While there are specific risks associated with staged tissue expander implant breast reconstruction, Dr Karatzias takes every precaution to mitigate these risks and has a track record of providing superior, natural-looking results for our patients. The risks related to expander implant breast reconstruction include general risks such as infection and wound healing problems as well as the more specific risks associated with breast implants. Over time, the natural capsule that forms around a breast implant can become thickened and firm. This can result in capsular contracture, which may be visible and, in severe cases, may be painful. Additional potential problems associated with implants include implant related contour deformities such as breast skin rippling and implant malposition. Any of these, or other implant related problems, may be corrected with secondary or revision provisions. In rare cases, patients may choose to convert an implant breast reconstruction to an autogenous tissue flap reconstruction. The main benefit of implant-based breast reconstruction is that a donor site for flap harvest is not required, avoiding additional surgery elsewhere in the body.

Are You the Right Candidate?

Most women that are undergoing mastectomy are candidates for staged tissue expander-implant breast reconstruction. This approach is ideal in women who do not want to have a flap procedure or for those who do not have any good flap options for breast reconstruction. Placement of an expander requires good quality skin at the mastectomy site and may be problematic in the setting of prior radiation. Risks are also higher in patients with obesity and very large breasts.

Dr. Karatzias is a leader in the field of breast reconstruction and is experienced with the most modern and innovative techniques. If you require a mastectomy, we can help you through the process of treatment and recovery. Dr. Karatzias uses the most advanced surgical technology, disposables and techniques when performing his treatments / procedures to maximise your results and diminish the length of your recovery period.