How is breast reconstruction using an implant performed?

Stuart A. Linder, MD
Plastic Surgery

Breast reconstruction after a mastectomy is usually performed in 2 stages. The first stage can be performed concurrently with the general surgeon performing the lumpectomy or mastectomy. It consists of placement of a tissue expander under the muscle on top of the chest wall. This expander will be filled with saline every week, thereby increase the space under the skin to place a final prosthesis. After about 3-4 months, a permanent silicone gel implant is placed under general anesthesia. Drainage tubes may be placed if necessary. 

During this 2-hour operation, a breast expander (a balloon like device made from silicone rubber) is placed in a deflated state under the tissue that remains from the breast that’s been removed. For several months thereafter, the patient goes to the doctor’s office for repeated injections of small amounts of sterile saline (salt water) by means of a small needle through the skin. The saline gradually expands the device, and the tissue over it begins to stretch. This creates a breast-shaped pocket for a breast implant. A patient may feel pressure or discomfort, which subsides as the tissue expands. When the expander has been inflated to the desired size, there is a second outpatient procedure (often under local anesthesia and intravenous sedation, though it may also be done under general anesthesia). The expander is removed and replaced in the pocket with a permanent implant. After reconstruction is complete, the nipple and areola are reconstructed in the plastic surgeon’s office under local anesthesia. The nipple is reconstructed with flaps of skin at the site, and the nipple and areola are tattooed to the appropriate color. Occasionally, skin grafts may be used in the procedure.

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