Implant based reconstructions.
There may be many reasons to choose an implant based reconstruction: it involves relatively quick operations and it does not leave scars anywhere else on your body. As with all operation s there are of course potential complications and you are committing yourself to at least one more operation to exchange the implants.
If you have had a skinsparing mastectomy an implant can be placed under the chest muscle (pectoralis major) and possible under part of the muscle at the side of your chest, at the time of mastectomy. Your skin is draped around the implant to make the final breast.
If you have a traditional mastectomy, you are short of skin and we need to expand the skin on your chest to fit an implant underneath it. At the first operation an expandable implant is placed under the skin and the big muscle on the front of your chest (pectoralis major).
This implant is flat when it is put in and is gradually expanded allowing for you skin to stretch. This operation can be done as a daycase or you can stay one night in hospital. You will have a drain from the operation site, which is usually removed the next day. The expansion is started one to two weeks after the initial operation. The sterile water used for the expansion is injected through your skin with a tiny needle into the port via a small port: this port can either be placed on the implant itself or a few centimeters away connected to the implant with a small tube as shown below. In the latter type you can feel a bump under your skin where the port is.
Over the next 1-3 months a nurse will inflate the implant gradually with sterile water on a weekly basis. It feels a little tight each time, but the feeling soon disappears and you are ready for another top-up. Some patients find it more tolerable if they take a few simple painkillers before each session, such as paracetamol.
The expandable implant is inflated to be larger than the other side, because we need more skin than just to cover the implant, we want a little normal droop in the reconstructed breast and for that I need more skin. The difference is not dramatic, you will easily be able to conceal the difference in size in clothes. This over-inflation is left for a couple of months to allow for the skin to stretch, before a permanent implant is inserted, again in an hour long operation done as a daycase or with one overnight stay.
The final size is something you can decide, though if you had very large breasts, you may consider reducing the opposite side as the reconstructed breast will always be far perkier than the other side. You can choose between round implants and anatomical implants:
For patients who have had radiotherapy it is controversial whether to use implants. If the decision is still made to go ahead, implants with a special coating (polyurethane) are used. They are firmer than normal implants, but cause less capsule formation.
In choosing an implant based reconstruction you are committing yourself to at least one more operation to exchange the implants, you may achieve almost perfect symmetry in a bra, but without one the reconstructed breast is more perky than the other side. This can be corrected to some degree by inserting an small implant in the other side.
The time from start to finish is about 6 months and you need two weeks to recover from the first operation and a week for the second.
If you have radiotherapy on an implant it may produce very bad capsule formation, i.e. the internal scar around the implant becomes thick and hard.
The potential complications of an implant based reconstruction are:
Bad scars
Infection, where the implant needs to be removed, we wait till the infection has settled and then we re-insert it
Asymmetry (both size and droop)
Capsule formation (much increased if you smoke or have had radiotherapy)
Bleed or seroma around the implant which needs draining
Visible rippling and edge of the implant if you are very slim
Wound breakdown (if you smoke)
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