In General
Breast reconstruction with the use of tissue expanders – silicone implants is probably the most widely used surgical method of breast reconstruction after mastectomy.
Reconstruction is completed in 2 stages.
1st Stage:
During the operation or in delayed treatments (women who have already undergone a mastectomy), a tissue expander is placed in the muscles (pectoralis major chest muscle, serratus anterior muscle, rectus abdominus muscle) in order to achieve full muscle coverage (ie the tissue expander to be fully covered by the muscles).
This is very important because it reduces or nearly eliminates the risk of complications from infection due to the very good perfusion of muscles. Furthermore if the reconstruction is performed in the same time with mastectomy, then the patient can complete all stages of the treatment (chemotherapy - Radiation) every 10-15 days. The tissue expander gets expanded by the use of saline which is inserted in the expander through a special valve and we the use of a very small needle.
The whole process is painless and is performed in the doctor’s office until we reach the desired volume.
Once the dilatation is completed we replace the tissue expander with a permanent silicone implant.
At the same time we perform simulation to the other breast (lifting, reduction or implant placing) in order to achieve uniformity and symmetry between the two breasts.
The simulation process can be performed during the 1st or 2nd stage of reconstruction depending on the patient’s will.
2nd Stage:
Second stage is usually performed 3-6 months after the placement of the tissue expander.
During 2nd stage we remove the tissue expander and replace it with a permanent silicone implant.
Nowadays silicone implants used for breast reconstruction are anatomical and in comparison to the round silicone implants they provide a more natural result.
At the same time we perform simulation of the other breast.
The Surgery
The surgery is performed under general anesthesia and it lasts 1-2 hours depending on the case. The patient leaves from the hospital the same day wearing a special bra.
There is no sutures removal as they are absorbable.
The patient gains full activity from the very next day, though it is advisable to avoid intense workout and fatigue for 10-15 days.
He can return to work after 5-10 days.
Complications
Complications are very rare especially if the initial positioning of the tissue expander is of full muscle coverage.
Possible complications are infection, improper positioning of the implant (higher or lower) as well as capsular contracture formation after a certain period of time.
Nowadays by the use the new technology which involves insert of rough surface implants with an anatomical shape, capsule formation i.e. hardening of the tissue surrounding the implant is not a common complication.
In conclusion
In conclusion, breast reconstruction after mastectomy using tissue expanders - silicone implants is a simple and convenient reconstruction method with a minimum of hospitalization and postoperative recovery, which if applied to the appropriate candidate with the right body type for this procedure then the outcome is natural and spectacular, offering a new natural breast in place of the former amputated breast.
The Surgery
The surgery is performed under general anesthesia and the duration varies depending on whether there is an adjustment to the other breast or not.
In the case of no altering the surgery lasts 1 hour and the patient is transferred to a hospital room wearing a special bra.
The use of drainage (special tubes placed in the area) is not always necessary.
Recovery
In many cases the patient can return home the same day even if there has been reshaping of the healthy breast as well.
In cases where the 1st stage of reconstruction is performed with skin sparing mastectomy the patients return home the following day.
There is no sutures removal as they are all absorbable.
The patient is ready for the procedure of stretching after 2 weeks.
Complications
The main complication is infection due to the existence of a foreign body and for that reason full muscle coverage is a necessity.
The wrong placement of the tissue expander (usually higher) is a matter of plastic surgeon’s experience.
Autologous tissue and silicone implants combination
In General:
The combination of autologous tissue (tissue from our own body) and silicone implants is a widely used reconstruction method in many reconstruction centers of Europe and N. America.
The advantage of this method is that we use a quite smaller silicone implant (in comparison to the reconstruction method with silicone implants alone) since we have autologous tissue transfer.
The use of autologous tissue and the small implant provide a natural, healthy well shaped breast which has a better behavior in comparison to the one with a silicone implant.
The greater the proportion of transferred normal tissue the more natural and long lasting result we achieve.
Furthermore we have a reduced risk of complications. Infections, capsular contracture formation and asymmetry occur rarely.
The tissue used for breast reconstruction with this method is the latissimus dorsi muscle. It is a muscle located in the lower back and when used for breast reconstruction does not affect the functionality of the body or the patient’s activities in any way.
The latissimus dorsi flap method is chosen usually for women who have undergone radiotherapy after mastectomy and therefore silicone implant reconstruction is a contraindication.
For these women the use of autologous tissue is the method of first choice in breast reconstruction. Other than that this method is used daily in clinical practice and in comparison to breast reconstruction with silicone implants alone it has a superior and more time lasting outcome.
The surgery
The surgery, immediate or delayed is performed under general anesthesia. Latissimus dorsi muscle and a small silicone implant are placed in the amputated breast area in order for the patient to have a well-shaped breast without the need of a future reconstructive intervention.
It is probably one of the best, most modern innovative immediate breast reconstruction techniques. The result is excellent, natural and long lasting, eliminating almost all the known complications (infection, capsule) that result from the use of silicone implants alone.
The patient may be subjected to any additional treatment (chemotherapy, radiation) necessary without compromising the oncological safety of the patient and the aesthetic outcome.
In my opinion the use of silicone implants alone provides a poor cosmetic result and does not guarantee the completion of the patient’ s remaining treatments (chemotherapy – radiation) without complications.
During the 2nd stage we remove the tissue expander and replace it with the latissimus dorsi muscle (with or without an incision placement) and the small silicone implant.
This may be done either due to the need to perform radiation treatment in which case placing a silicone implant alone is a contraindication, or because the patient desires a superior cosmetic outcome.
The latissimus dorsi muscle can be removed through a small incision 4-6 cm in a horizontal orientation that lies directly on the line of the bra without being visible or through the mastectomy incision.
The placement of an incision depends on whether there is a need for extra skin in the anterior chest wall area or not which might occur due to radionecrosis, or for the creation of a new areola.
The new breast has no scars, it is untouched. If the latissimus dorsi is removed without an incision in the back we have the natural, long lasting result.
In many studies and assays it is probably the gold Standard of reconstruction.
The surgery lasts about 4-5 hours, not due to the severity of the procedure, but due to the technicalities in order to create the breast.
The patient remains hospitalized for 2 days maximum.
Over a period of 5- 7 days the tubes are removed and the patient can return to everyday life in 8-10 days.
The patient wears an elastic waist belt for 15-20 days in order to avoid lower back effusion.
At the same time we perform adjustment to the opposite breast.
The patient gains full activity 15 days after the surgery completion.
Complications
Infection, post-operative infection, capsule formation are the complications which we usually face in all reconstructive methods. Although in this technique we have significantly less complications.
In conclusion
Is the most modern secure and long lasting result in the field of plastic surgery.
The operation if performed by experienced Plastic Surgeons, provides safety and quick recovery offering a spectacular aesthetic result.
On the other hand the transfer of latissimus dorsi muscle from the back to the mastectomy area, provides another great advantage. It provides significant improvement to women suffering from lymphedema in the upper end due to the new lymphatic system that the muscle creates after 1-2 years, relieving the problematic area.
Through the same mechanism it helps women who have undergone axillary lymph node clearance. Completing the description of this method we would like to say is the most modern reconstruction method with a plethora of advantages, which eliminates all the risks and complications that a reconstruction with silicone implants alone could cause.