This is a very common method of breast reconstruction in Houston, The Woodlands, and Conroe, Texas. It is typically performed at the time of mastectomy in the majority of cases. Dr. Gill will typically choose to place a tissue expander implant, an adjustable implant, placed under the muscle and the skin at the time of your mastectomy. The rationale for using this adjustable implant is that we want to be very careful with the overlying mastectomy skin. This skin that remains after the breast tissue has been removed has a very week blood supply. Any external or internal compression on the skin can increase the chance of skin loss. For this reason, we place an adjustable implant, which allows us to put approximately 30 to 40% of the initial volume back in surgery. This allows the skin to heal safely by minimizing tension and compression on the skin. Once the patient returns to the office we can then begin to add volume back to the adjustable implant/expander until we reach the patients desired size.
We will then perform a second outpatient procedure to remove the adjustable implant/expander and replace it with a softer more shapely implant for the final reconstruction. This is usually performed one month after the last expansion to allow the skin to relax and get used to its final volume. This second procedure also allows us to do any symmetry procedures to the opposite breast. The goal of the second procedure is to obtain final shape and symmetry. We will often use a shaped silicone gel gummy bear implant to reconstruct the final breast. This second procedure is outpatient and patients can usually return back to a desk job within 3 to 5 days. Once our patients have healed from this second stage breast reconstruction procedure, we will then arrange for a nipple reconstruction at about two months post procedure. The rationale for this is that we want to give time for both the reconstructed and opposite breast to settle so optimal symmetry can be achieved. We can then complete the procedure with areola tattooing in the office.
The recovery is not much different than if a patient had bilateral mastectomy alone. The tissue expander surgery only adds approximately 30 minutes to the mastectomy surgery per side. The patient will usually stay one night for one mastectomy and two nights for bilateral mastectomy with reconstruction. We typically find patients require pain medication and drains in place for approximately two weeks. Our general goal is by two weeks to have patients off pain medication, with the drain tubes removed. At this point we feel comfortable beginning the expansion process.
The advantage is that it offers less downtime in comparison to the tissue reconstruction. There is less short-term risk, in terms of less anesthesia, less overall recovery, quicker return to work, and daily activities of life. The added benefit is there is no requirement for a donor site incision.
Implant reconstruction carries a higher risk of long-term complications such as scar tissue formation/capsular contracture, infection, and implant rupture. In addition, all of our plastic surgery patient questionnaires show a lower rate of satisfaction with implants in comparison to tissue. The reason the implants present with a higher risk of long-term problems is due to lack of blood supply. With the breast tissue removed during the mastectomy surgery, blood supply to the remaining skin is substantially weakened. With placement of a large foreign body implant in an area of weakened blood supply, the risk of infection and scar tissue are much higher. Therefore patients present a high-risk of capsular contracture and long-term infection related issues when it comes to the implant choice. However, we always inform patients that it is possible to change reconstruction methods down the road if these issues arise. Hence, if the patient has implant related complications and no longer desires this reconstruction, we can always proceed with tissue reconstruction at that time.