Overview of Postoperatively Adjustable Breast Implant
Breast cancer is a common illness in women globally, affecting an estimated 12.5% of women in the United States. As a result, genetic testing for breast cancer genes has become increasingly popular to identify women at a high risk of developing the disease. Because of this, preventative removal of the breasts, or mastectomies, along with reconstruction afterwards is almost as common as surgeries carried out to cure breast cancer. Up until 2002, reconstruction using the patient’s own tissue was the preferred method. The use of medical devices, such as silicone implants, for breast reconstruction started in the 1960s.
Since 2008, the use of implants for reconstruction has become more popular and now accounts for about 65% of all reconstructions. Implant-based reconstruction has some advantages over other types of breast reconstruction. The surgery is fairly straightforward and takes less time; unlike reconstruction using the patient’s own tissue, there are no complications from where the tissue is taken and recovery is faster. This method allows the skin to be preserved, uses a tissue expander which helps the patient to decide on the final implant size, and allows the patient to start chemotherapy without delay. Other factors to think about with this type of reconstruction are whether it is done in one or two stages and where the implant is placed—either above or below the chest muscle.
Anatomy and Physiology of Postoperatively Adjustable Breast Implant
The breast, or mammary gland, is located on the chest, just beneath the skin. It’s considered a ‘subcutaneous’ organ, which means it’s located just below the surface of the skin. The boundaries of the breast include the collarbone (or clavicle) above, the lower crease of the breast below, the sternum (breastbone) on the inside, the serratus anterior muscle (located on the side of the chest) on the outside, the pectoral muscles (chest muscles) at the back, and the skin at the front. The breast usually stretches from the second to the sixth ribs.
The ‘subpectoral space’ is the area that follows the major chest muscle at the front, the rib cage and the smaller chest muscle at the back, the chest muscle on the side, and the tissue beneath the skin at the bottom. This space is typically covered with a surgical flap of tissue after a mastectomy, which is a surgery to remove breast tissue.
The ‘pre-pectoral space’ is defined as the space between the chest muscle cover and the surgical flap of tissue after a mastectomy.
Why do People Need Postoperatively Adjustable Breast Implant
If you require breast reconstruction in both breasts, the procedure is generally more suitable if you have small to medium-sized breasts. However, if you need reconstruction in only one breast, the other breast may also need surgery, which could involve lifting, reduction or enlargement, in order to match the appearance of the reconstructed breast.
Patients with larger breasts can also opt for a breast implant-based reconstruction if they agree to have the size of their skin or breasts reduced, and to have a surgery on the other breast for balance. Alternatively, these patients can consider a different type of breast reconstruction process, which involves using their own body tissues, known as autologous tissue breast reconstruction.
When a Person Should Avoid Postoperatively Adjustable Breast Implant
There are some medical conditions that can make it risky to put breast implants under the skin. These conditions include scleroderma (a disease that causes hardening and tightening of the skin and connective tissues), previous radiation therapy, and a history of smoking. For patients who have had radiation to the breast, they may be at a higher risk of infection and the implant may not stay where it is supposed to. As a result, it is often preferred that these patients have reconstruction using their own tissue.
If a patient is expected to have radiation therapy after having their breast removed (mastectomy), it is usually better to wait until after the radiation therapy is finished before putting in implants. This is because the radiation therapy could affect the implants.
There are also certain situations where it is not safe to place the implant under the skin but over the chest muscle (this is called ‘pre-pectoral’ or ‘subcutaneous’ placement). These situations include patients who have a high body mass index, a history of smoking, and those that have had radiation before the surgery. These conditions pose a higher risk of the implant not staying in place.
Equipment used for Postoperatively Adjustable Breast Implant
Tissue expanders are used to increase the amount of available skin before placing a breast implant. There are two types of tissue expanders: one filled with compressed carbon dioxide and the other filled with a salt water solution called saline.
Salt water or saline tissue expanders are filled gradually with more saline in a clinic on a weekly or every other week basis until the desired size is reached. This process, however, might lead to patient discomfort and anxiety as it involves injections with a needle into the skin. It also increases the risk of getting an infection. Another possible problem can be damage to the skin from too much pressure from the sudden expansion of skin. On a positive note, the use of saline does not need the adjustment of radiation therapy if it’s needed for cancer treatment, and the saline can be removed if necessary.
Carbon dioxide expanders, on the other hand, can be controlled remotely by the patient at home. This allows for a gradual increase in size without needing injections, reducing the chance of infection. The desired size can be reached faster than with saline expanders. Radiation therapy can still be given to patients with this type of expander, although changes might need to be made to the therapy. However, one downside is that the carbon dioxide cannot be removed from the expander if required. Unfortunately, the company making this product shut down in 2019, so it is no longer available.
Breast implants, filled with either saline or silicone, are still a popular choice for breast reconstruction. In case the implant breaks, those with saline implants may feel safer because only saline would be released into their body. However, saline implants tend to only last 10-15 years, they can be felt under the skin and can lead to visible ripples on the skin. Silicone implants, in contrast, are lighter, last up to 25 years, and look more naturally shaped with fewer ripples. Regardless of fill material, there is a very small risk of developing a rare type of cancer called breast-implant associated anaplastic large cell lymphoma, but this is only linked with textured implants.
A material referred to as ADM (acellular dermal matrix) can be used in breast reconstruction, and is sourced from pig, cow, or human tissue, or can be artificially made. This material is used to strengthen soft tissue and helps keep the implant within the boundaries of the breast. Although it is aseptic, meaning it’s free of bacteria, there might be a higher risk of infection since it isn’t completely sterile.
Lastly, surgical drains can be applied to remove any fluid build-up, whether it’s a collection of clear bodily fluid called seroma or blood from a hematoma. Different sizes of drains are available and the surgeon will choose the most suitable one for the situation.
Who is needed to perform Postoperatively Adjustable Breast Implant?
This type of medical procedure needs a team of experts to ensure everything goes smoothly:
– A breast cancer surgeon or a general surgeon will be leading the procedure. These doctors specialize in treating breast cancer or doing all kinds of operations respectively.
– A plastic surgeon will also be on hand. This doctor specializes in reshaping and rebuilding parts of the body.
– There will also be an operating room support team. This group of healthcare professionals assists the doctors during surgery.
– Lastly, medical and radiation oncologists might be involved. These doctors use drugs (medical oncologists) or radiation (radiation oncologists) to treat cancer.
Every member of this team has been trained to make sure the procedure is successful and safe.
Preparing for Postoperatively Adjustable Breast Implant
Before a breast cancer surgery, it’s crucial for all the medical professionals involved, including the surgeon, oncologist, and plastic surgeon, to communicate closely. It’s especially important for the surgeon to measure the size and placement of the breast before the patient goes into surgery. This includes measuring the distance from the collarbone to the nipple, the distance from the nipple to the crease under the breast, and the overall width of the breast. Measuring while standing up can give the most accurate results.
Another key factor in the pre-surgical plan is for patients who smoke to quit before any type of breast reconstruction. This is because smoking increases the risk of complications like skin infections and tissue death. It’s recommended that patients stop smoking for at least three weeks before their breast reconstruction to ensure the best possible results.
How is Postoperatively Adjustable Breast Implant performed
After a breast removal surgery, or mastectomy, the surgeon checks the skin flaps to make sure that there is enough blood flow to the area. They can tell this through changes in temperature, color, and bleeding of the skin. There are also specific tests, like laser-assisted angiography, that can help determine this.
When it comes to reconstructing the breast immediately after a mastectomy, there are two main methods: single-stage and two-stage reconstruction. Both of them have their benefits and are increasingly being used.
In the single-stage method, a combined tissue expander and implant are inserted during the same operation. This expander is adjustable and can be changed by the patient themselves in regular outpatient visits. This method only requires one surgery under general anesthesia, and the only follow up routine involves removing the adjustable port, which can be done with local anesthetic at the clinic. The risk of complications with this method is about the same as with the two-stage approach.
In the two-stage approach, a tissue expander is placed during the initial mastectomy surgery. This expander is gradually increased in size over time to achieve the desired breast size. Once the ideal size is achieved, a second surgery is performed to replace the expander with the permanent implants.
During implant-based reconstruction, the implant is placed in a pocket that is precisely made under the pectoralis major muscle by separating the muscle from its lower and inner attachments. Great care is taken not to injure any important blood vessels during this procedure.
Alternatively, the implant can be placed in what’s known as the pre-pectoral (subcutaneous) space, which is under the skin but above the muscle. Here, the implant is attached to a mesh or special type of skin matrix before being secured in place.
To help support the implant or tissue expander, a special type of skin matrix or synthetic mesh is often used. It is attached at the bottom of the breast to create a sort of sling for the implant or expander. Some studies suggest that using these materials could potentially minimize complications when placing an implant beneath the skin.
Possible Complications of Postoperatively Adjustable Breast Implant
There are two methods for breast implant placement – subpectoral (under the muscle) and pre-pectoral (under the skin). Each method has its own set of advantages and potential complications.
The subpectoral method tucks the implant under the muscle, providing an extra layer of tissue over the implant and preventing it from moving downwards. But there can be some downsides, such as more pain after the surgery due to the muscles being cut. Some other complications could include the breast moving oddly when the muscles are flexed (animation deformity), issues with shoulder movement, and the breast might look less natural because the implant is under the muscle.
On the other hand, the pre-pectoral method places the implant right under the skin, leaving the muscle layers untouched. The main advantage is that it provides a more natural-looking breast and less pain after surgery since the muscle isn’t disturbed. However, this approach may cause complications such as capsular contracture (a painful condition where a rigid shell forms around the implant leading to a deformed breast), implant loss or exposure, the implant moving from its original position, and decreased blood supply to the skin over the implant.
Capsular contracture is seen more often in breast reconstruction patients compared to those who get breast augmentation. But, it’s less common in the subpectoral method, maybe because the movement of the muscle massages the implant and provides an additional barrier from bacteria. Furthermore, using textured implants rather than smooth ones can help lessen the risk of capsular contracture. A history of radiation treatment to the breast can increase the likelihood of this complication. Blood-filled swelling (hematoma) can also lead to capsular contracture, but this can be prevented using drainage systems that use suction to remove the blood. Other possible complications include fluid-filled swelling (seromas), death of skin tissue (skin flap necrosis), infection, and implant exposure or loss. It’s important to understand these possibilities when considering breast implant surgery.
What Else Should I Know About Postoperatively Adjustable Breast Implant?
As more and more people are undergoing double mastectomy surgeries with reconstruction, either as a part of breast cancer treatment or as a preventive measure, it’s essential for surgeons to be aware of different reconstruction methods. Breast cancer is a complex disease, and the treatment plan is tailored to each person’s unique situation.
Each type of reconstruction has its own specific benefits and potential drawbacks, and it’s important for both the doctor and patient to understand these. This understanding helps in deciding which reconstruction method will be most beneficial for the patient’s health and wellbeing. So, it’s vital to be aware of the reasons for choosing a particular type of reconstruction and when it might not be the right choice.
