Breast Reconstruction with Implants
Breast cancer will affect 1 in 8 women over the course of their lifetime. Surgical excision of the concerning area remains a mainstay treatment for breast cancer. This excision may involve only a portion of the breast (lumpectomy) or all of the breast tissue (mastectomy). Lumpectomy and mastectomy are procedures performed by a Breast Surgeon. Dr. Pierce works collaboratively with multiple Breast Surgeons in southern Colorado to assist with breast reconstruction.
Options for breast reconstruction after mastectomy include using an implant or using the patients own tissue (autologous reconstruction). Implant-based breast reconstruction is currently the most common technique used after mastectomy. This technique usually involves multiple stages to complete the reconstruction. The first stage of reconstruction begins at the same time as the mastectomy with placement of a tissue expander. A tissue expander is a temporary implant that allows Dr. Pierce to determine to ideal location of the final breast reconstruction and slowly expand the remaining breast skin to the desired reconstructed size. Inflation of the tissue expander is done in the office until the skin is stretched to an appropriate size. The second stage of reconstruction occurs 4-6 months after the initial surgery and involves removal of the tissue expander and placement of the permanent implant.
Other factors that may affect your options for breast reconstruction include:
Patient’s desires and expectations of reconstruction
Location of breast cancer
Size of breast cancer
Type of breast cancer
Current size of breasts
Prior surgery of the breasts, abdomen, or back
Prior radiation to the chest
Possibility of post-operative radiation to the chest
Body habitus or weight
Other medical issues
Ultimately, the decision to proceed with breast reconstruction should involve a discussion between the patient, the breast surgeon, and the plastic surgeon.
Frequently Asked Questions:
Am I a candidate for breast reconstruction?
Women who are undergoing mastectomy for breast cancer and are in otherwise reasonable medical health are candidates for breast reconstruction.
Is breast reconstruction covered by insurance?
Breast reconstruction is usually covered by insurance. Our office will be able to help determine if this procedure is covered by your particular insurance plan.
Can I have a breast reconstruction if I am currently smoking cigarettes?
No, smoking cigarettes or any form of nicotine consumption significantly increases your risk of issues with wound healing and infection. You should be without nicotine for 6 weeks prior to and 6 weeks after your surgery. Your breast reconstruction can begin once you have discontinued any nicotine.
How is a breast reconstruction with implants surgery performed?
Breast reconstruction with implants is typically performed in multiple stages. The first stage of reconstruction begins at the same time as the mastectomy with placement of a tissue expander. A tissue expander is a temporary implant that allows Dr. Pierce to determine to ideal location of the final breast reconstruction and slowly expand the remaining breast skin to the desired reconstructed size. Inflation of the tissue expander is done in the office until the skin is stretched to an appropriate size. The second stage of reconstruction occurs 4-6 months after the initial surgery and involves removal of the tissue expander and placement of the permanent implant.
Where are the incisions located for a breast reconstruction with implants?
Because breast reconstruction is performed after a mastectomy, it is common to used the mastectomy incisions for the reconstruction. Mastectomy incisions are determined by many factors including breast cancer size/location, previous incisions on the breast, patients current breast size and desired final breast size, etc. The most common types of mastectomy incisions include transverse skin-sparing, reduction pattern, radial nipple-sparing, and inframammary fold nipple-sparing. The ideal location of your incision will be discussed during your consultation. Please visit our breast reconstruction with implants gallery to see typical incisions after this procedure.
How long does breast reconstruction with implants surgery take?
Placement of a tissue expander during the first stage of breast reconstruction takes approximately 1 hour per side. Removal of the tissue expander and placement of the permanent implant during the second stage of breast reconstruction takes approximately 1 hour per side.
Will I have drains after a breast reconstruction?
You will have 1 drain in each reconstructed breast after placement of the tissue expanders. The drains will be removed in the office 1 week after surgery. Dr. Pierce does not commonly use drains during the second stage of reconstruction to remove the tissue expander and place the permanent implant.
How do you control pain during and after surgery?
Dr. Pierce uses an evidence-based approach to pain management for surgery called the ERAS (Enhanced Recovery After Surgery) protocol. This protocol uses a combination of local numbing medication, anesthesia blocks, anti-nausea medication, scheduled non-narcotic pain medication, and narcotic pain medication as needed to decrease the surgical pain and speed up your recovery.
Where do you perform breast reconstruction with implant surgery?
Dr. Pierce performs the first stage placement of the tissue expanders in a hospital setting since this procedure is most commonly done in conjunction with the Breast Surgeon at the same time as the mastectomy. The second stage surgery for removal of the tissue expanders and placement of the permanent implants can be performed in a hospital or ambulatory surgery center.
I’m a candidate for nipple sparing mastectomy. Will my nipple sensation change?
Yes. You will lose all sensation and function of the nipple and areola as a result of the mastectomy. A mastectomy removes of all nerves that pass through the breast tissue to the overlying skin.
What are the risks and complications associated with a breast reconstruction with implants?
The most concerning initial complications after this surgery are loss/necrosis of the mastectomy skin and implant infection. Loss/necrosis of the mastectomy skin may require additional surgery to remove unhealthy skin. Implant infection may require additional surgery to exchange the implant or remove the implant entirely to allow the area to heal or the infection to resolve. Other common risks include pain, bleeding, infection, delayed wound healing, scarring, asymmetry, and capsular contracture.
What is capsular contracture?
Capsular contracture is a thickening of the natural scar tissue that forms around a breast implant. In most patients, the capsule or scar tissue is very thin and soft (Grade 1). In some patients, the body overreacts to the breast implant and forms a thicker capsule. Thickening of the capsule can result in a firm breast (Grade 2), a firm breast with distortion (Grade 3), or a firm breast with distortion that is tender to the touch (Grade 4). The risk of capsular contracture is significantly higher in women that have had radiation to the chest after mastectomy.
How do you treat capsular contracture after breast reconstruction?
Capsular contracture after breast reconstruction does not necessarily require treatment unless you are symptomatic. The treatment options consist of removal of the current implant and entire capsule with either no additional reconstruction or conversion to autologous reconstruction (see breast reconstruction with DIEP flap).
When can I return to work after breast reconstruction with implants?
You can return to desk work 1-2 weeks after surgery. If you have a job that requires heavy lifting, we ask that you request to return to work with modified duties until 6 weeks after surgery.
When can I return to exercise after breast reconstruction with implants?
You can resume low-impact exercise (ex: walking, stationary bike, elliptical) at 1-2 weeks after surgery. You can resume high impact exercise (ex: running, cycling, weight lifting) at 6-8 weeks after surgery.