This can be done in one or two stages. The two-stage procedure is still the most commonly performed technique, however in suitable patients it can also be performed in a single procedure, often with the use of acellular dermal matrix (ADM). ADM is made from the skin from a human body (donated cadaveric skin) that has been specially prepared for your body. Another way of performing single stage implant reconstruction uses an adjustable implant that can be filled over time to expand the skin and achieve the ideal volume.
Two-stage tissue expander-implant reconstruction
In two-stage implant reconstruction, the breast mound is first created by placing a saline-filled tissue expander under the skin and muscle of the chest. Because the skin as well as breast tissue are removed at the time of mastectomy, it is usually necessary to stretch the remaining skin and chest muscle before inserting the permanent breast implant. The temporary implants (tissue expanders) achieve this gradual inflation using saline injections. The expansion procedure is repeated during fortnightly clinic visits.
After the expansion process is completed adequately enough for the chest skin to hold the chosen implant size, the patient returns to hospital to have the tissue expander removed and replaced with a permanent breast implant. The breast implants used by Dr Sharp are explained here. This procedure is performed under general anaesthesia, usually as day surgery. The expanded skin is fashioned into the final breast shape during this procedure, and again a dermal matrix may be used for support of the implant, and to create the inframammary fold. If you are having a unilateral (one breast) reconstruction, it is also possible to reduce or lift the opposite breast at the same time if desired, to create more symmetry.
In a single-stage implant reconstruction, an adjustable implant/tissue expander is used. The plastic surgeon places the adjustable implant under the skin and muscle just like a traditional tissue expander, and fills the device over time with saline. The difference is that the device is designed and engineered as a permanent implant. When the ideal volume is achieved, the plastic surgeon can remove the fill tube and close the internal valve in a clinic setting, leaving the device as the permanent implant. The advantage of single-stage implant reconstruction is that only one surgery, one general anaesthesia and one recovery period is required.
If your breast tissue has been previously treated with radiation, then an implant reconstruction alone may not be recommended.
The implant is placed in a pocket that is made between the chest muscle (pectoralis major) and the rib. The incision to make the pocket is done through the mastectomy incision. The muscle and skin are closed and allowed to heal for 2–3 weeks. Implant based reconstruction can be done in a single stage (one surgery under a general anesthetic) or in two stages (two surgeries under a general anesthetic).
- Surgery time: About 1 hour to place the implant or expander
- Hospital stay: Day surgery — occasionally one night stay
- Recovery time: 2–3 weeks to fully heal the incision, restricted movement for 6 weeks
- To expand the pocket: 2–3 months, weekly or bi-weekly visits