Breast Reconstruction With Implants

Breast reconstruction with implants may be performed using a fixed-volume definitive silicone implant or using an inflatable tissue-expander (which can be inflated or deflated with saline in  the surgeon’s rooms). The expander can then be replaced with a definitive breast implant at a second stage.

Generally speaking, women with small to moderate sized firm breasts will do well with an implant-based reconstruction.  The firmness of the breast is an indirect indicator of the elastic recoil of the breast skin, and hence the ability of the breast skin to hold the weight of a breast implant, leading to better aesthetic results.

The position of the nipple or breast ptosis (droop) is important in determining if you are safely able to conserve the nipple during mastectomy.

If you have previously undergone or will require radiotherapy following mastectomy, implant-based reconstruction is best avoided as the results are poor.

When the reconstruction is performed with a definitive implant, this is referred to as direct-to-implant (DTI) reconstruction. An implant is placed under the Pectoralis major muscle in association with an Acellular Dermal Matrix (ADM). The ADM offers support for the implant and there is some evidence to show that the rate of capsular contracture (hardening of the capsule that forms around the implant) is significantly less.

‍Reconstructing a breast after mastectomy with breast implants may sound straight-forward, but it can prove a more complicated process than a reconstruction with an autologous flap. The outcome of an implant-based reconstruction is highly dependent on the quality of the mastectomy performed by the breast surgeon.

Your breast surgeon and plastic surgeon work in close conjunction to reduce the risk of complications, and should you choose to preserve your nipple, a ‘nipple delay’ procedure is done 10 to 14 days prior to your reconstruction procedure. This will increase the blood flow to the nipple and some of the breast skin thus reducing the risk of nipple necrosis (nipple death). The breast surgeon will often take the opportunity to perform nipple duct biopsies and sentinel lymph node biopsies at this time, to ensure that all bases have been covered from a cancer safety point of view.

Several issues relating to the mastectomy can compromise the success of an implant-based reconstruction:

• Problems with blood flow to the skin that is preserved can result in native mastectomy skin necrosis (skin death) which may require removal of the implant and skin grafts.
• Irregularity in the thickness of the skin that is preserved resulting in contour abnormalities or asymmetry in the reconstructed breast.
• Disruption of the natural ligaments that form the supportive boundaries of the breast resulting in a less than aesthetic appearing breast.

All implant-based reconstruction may require multiple procedures. Depending on whether the reconstruction is direct-to-implant or 2-stage with a tissue expander, there may be a requirement for a second procedure as a planned event. This can consist of symmetrising procedures (balancing out the other breast), nipple reconstruction or fat transfer.