Overview of Breast Reconstruction Expander Implant
Doctors first began reconstructing breasts with artificial implants in the 1960s. At first, they would insert a permanent implant into the breast during the same operation where the breast was being removed because of cancer. But now, breast reconstruction has become a process that takes place over several stages and can stretch over weeks or months.
First, the surgeon inserts a device into the breast area called a tissue expander. Over time, this device is gradually filled with liquid to slowly stretch the skin and create space for a breast implant. Once the skin has stretched enough, the tissue expander is removed and replaced with a permanent breast implant.
This method of breast reconstruction is often chosen by patients undergoing a mastectomy because it’s relatively straightforward and doesn’t add much extra time to the initial surgery for the breast removal. The tissue expanders can also be put in after the initial surgery as a delayed procedure, which is later followed by the swapping out for the permanent implant.
Anatomy and Physiology of Breast Reconstruction Expander Implant
The process used to rebuild the breast is much like what’s done during breast cancer surgery. The bottom edge of the breast, known as the inferior mammary fold, is very important to the surgeon. This fold tells them where to make a pocket for the tissue expander, a device used to create space for the new breast. This not only affects the height and location of the new breast, but also the space between the breasts, known as the cleavage.
If the surgeon works too far towards the middle of the chest, it can cause a condition called symmastia, where the breasts appear to be connected. If the tissue expander is placed in the wrong spot up or down, or if the surgeon works too far towards the bottom of the breast, it can lead to breast dystopia. This is when the breast doesn’t look right because it’s too high or too low.
Why do People Need Breast Reconstruction Expander Implant
Breast expanders and implants can be a good choice for many patients who need a breast reconstruction. This could be an option even when rebuilding the breast using the patient’s own tissue is possible. The ideal candidates for expanders and implants are usually thin individuals who are having both breasts removed or those having just one breast removed where the second breast droops a little to none. This is because creating a drooping breast with an implant can be very challenging.
However, the process may be complicated for patients with obesity or those with very large breasts on the other side. This is because the extra fat tissue can affect the final shape of the breast and make the implant placement operation more complex. Additionally, it might be more difficult to match the new breast to the existing one due to the thick fat layer under the skin.
The patient can choose to have the breast reconstruction right after the breast removal surgery, or they can delay it until a later surgery. This option may be selected if the patient is unsure about wanting reconstruction, or they want to know if they will need additional radiation therapy based on the final examination of the removed breast tissue. Having the reconstruction performed immediately offers the benefit of avoiding an additional surgery. Also, the plastic surgeon and the breast surgeon might be able to work together to save as much of the patient’s own skin as possible.
However, it is very important to note that the primary goal of the surgeon is to effectively treat the patient’s breast cancer. Therefore, the breast reconstruction should not interfere with the safety of the breast removal operation. If anything unexpected happens during the breast removal surgery, the reconstruction can be revisited later.
When a Person Should Avoid Breast Reconstruction Expander Implant
Choosing the right patients for a type of breast reconstruction using implants is very important, especially for those who may need extra cancer treatment with radiation. When a tissue expander (a device that stretches the skin to make room for the implant) is used for patients receiving radiation at the same time, it might fail to work properly. It could also lead to problems with wound healing and the final shape of the breast. The chance of these complications can be up to 60% when tissue expanders are used in the area receiving radiation.
Active smokers are particularly at risk of developing infections and having poor wound healing. These patients should receive advice on how to stop smoking. Many doctors may not perform breast reconstruction (especially using expanders and implants, and possibly even using the patient’s own tissue) for individuals who continue to smoke.
Equipment used for Breast Reconstruction Expander Implant
During surgery, many doctors have a range of differently shaped and sized implants to choose from. The most suitable choice usually depends on the area that’s successfully opened up during the operation. However, this can usually be roughly determined before the surgery by considering things like the patient’s Body Mass Index (BMI), the shape and position of the breast, and a thorough check-up. If the surgery involves a tight area behind the chest muscle, brightly lit surgical tools can be very helpful.
Who is needed to perform Breast Reconstruction Expander Implant?
The surgeon might need some help while performing the surgery. However, it’s up to the surgeon to decide if they need assistance or not. This means that the surgeon has the ability to make this choice based on what they believe is best for the procedure and your health.
Preparing for Breast Reconstruction Expander Implant
During your first meetings, your doctor should discuss all the possible treatment options with you, including what benefits each one offers and what risks are involved. If you are about to undergo a major procedure, it might be helpful to join a support group. In these groups, you can talk to others who have gone through the same process. This can give you a good idea about what to expect and you can hear people’s own stories about how they managed with different treatments.
The doctor will also give you antibiotics right before your operation. This is to lower the risk of any germs on your skin causing an infection in the wound after the operation.
How is Breast Reconstruction Expander Implant performed
Creating a pocket for an expander – a device used to create extra skin, is the same whether it’s done for the first time or as a repeat procedure. If done during the initial breast-removal surgery, the surgeon will use the skin flaps (thin layers of skin) to reach the lower corner of the pectoralis major muscle, a large muscle at the chest. The surgeon will then carefully separate this muscle from the chest wall, making sure not to break the natural fold underneath the breast.
Some surgeons may use a special material known as ‘acellular dermal matrix’ to aid this process. It can potentially help speed up the expansion and reduce pain, though this is based on personal experiences rather than scientific evidence. Once the pocket is created, a tissue expander is placed in this space beneath the pectoralis muscle. This is then closed over in layers. The tissue expander has a port (channel) on the front side, which is used for filling the expander with fluid over time.
A drain (a tube that allows fluids to flow out) is then put in place to get rid of any fluids that may collect after surgery. The skin is then sewn shut. The tissue expander is filled bit by bit over week or months to create extra skin enough to house a breast implant. The filling process involves the use of a magnet to locate the port, and then fluid is injected into the port under sterile conditions. Pain due to the filling process is usually managed with over-the-counter pain-relief medicines.
This filling process can occur alongside chemotherapy treatment; however, the white cell count must be normal for the patient before the expander is substituted with a permanent implant. Once the skin has stretched enough, the tissue expander is removed and replaced with a breast implant that the patient has chosen through discussions and consultations with the surgeon.
The choice for an implant can vary widely. Implants can feature a smooth or textured surface, contain saline or silicone gel, and be round or shaped to mimic the natural breast shape. It is important to discuss the advantages and possible risks with each type before surgery.
The process of replacing the expander with an implant is straightforward. The surgeon reopens the old cut, removes the expander, and inserts the chosen implant. If a ‘capsular contracture’ (a complication where the body forms a thick capsule around the implant) is present, the surgeon can perform additional procedures to correct it and achieve symmetry. In order to determine the correct implant, they might use a disposable sizing device. Sometimes, additional procedures like fat grafting, or mastopexy/mammoplasty (surgical reshaping of the breast) on the other breast may be needed to make the breasts match, though additional procedures may also be needed after healing.
Don’t worry, implants do not increase the risk of breast cancer. However, they do cause some difficulty with mammograms, so additional imaging tests might be needed. It’s also worth noting that there has been an increase in anaplastic large-cell lymphoma, a rare type of non-Hodgkin lymphoma, in people who have received specific types of implants. Although it’s a rare occurrence, it’s important to discuss this risk with patients.
After surgery, following instructions is key to a successful recovery. Patients should avoid bras with an underwire. Many surgeons recommend using a surgical bra that supports and helps in positioning the implant. Your surgeon might also prescribe an antibiotic to prevent infection. Proper post-operative care is vital!
Possible Complications of Breast Reconstruction Expander Implant
Issues that arise with tissue expanders and implants used in breast reconstruction are like those seen in cosmetic breast augmentation. During surgery, it’s vital to ensure there is no bleeding. Blood clots or hematomas can increase the risk of infection and cause scarring inside the tissue surrounding the implants. If a hematoma happens, it’s a medical emergency that needs immediate treatment to avoid harm to the skin and soft tissue. An infection of the expander or implant can involve multiple surgeries and may even require removal and reinsertion once the infection has cleared. Infections and bleeding each occur in about 1 to 2% of cases.
In some cases, overly aggressive inflation of tissue expanders can damage the skin by cutting off its blood supply. The patient should be informed to immediately report any persistent or unusually severe pain or changes in skin color. These symptoms might be an indicator of a serious issue, requiring a quick deflation of the expander. Long-term complications such as skin rippling, scarring around the implant, infection, and implant rupture are common and usually do not prevent successful treatment. Regular appointments to check on the implant for any delayed complications can catch any issues early.
Scarring around the implant can form, causing a firm feeling, moving its location, or even making the breast feel abnormally firm and painful. This is called a capsular contracture and is an extreme reaction to the foreign body. The extent of these contractures is measured on a scale called the Baker scale, with Grade I being a normal, soft breast and Grade IV being a hard, painful, and misshapen breast. Surgery might be needed for Grade III and IV contractures, while more frequent monitoring is required for Grade I and II.
It’s important to note that there has been some evidence linking implants to a rare type of cancer called ‘T-cell anaplastic large-cell lymphoma.’ Textured implants appear to be linked possibly due to chronic inflammation, bacterial buildup, or other unknown causes. This is a new reason for considering the removal of these implants, but more research into it is still ongoing. The estimated occurrence of this condition is thought to be about 1 in 2,400 to 1 in 30,000.
What Else Should I Know About Breast Reconstruction Expander Implant?
For patients who have had breast cancer, there are many different ways a reconstructive surgeon can help them feel normal again after their surgery. Some of these methods include using tissue expanders and breast implants. However, these solutions are not suitable for everyone and should be used carefully.
Tissue expanders and breast implants are a simple option for many patients and their effectiveness has been thoroughly researched and documented. However, they do require the patients to be actively involved in their care, willing to go through multiple surgeries, and frequently visit the doctor’s office.