Breast Reconstruction Beverly Hills - Implant Based Reconstruction

OPTION ONE: EXPANDER AND IMPLANT RECONSTUCTION

The first stage of implant reconstruction involves placement of a temporary, adjustable volume implant called a tissue expander. The expander is usually placed at the time of the mastectomy so that the reconstruction is begun immediately. Expander followed by implant reconstruction is the potentially simplest form of reconstruction, involving the shortest hospital stay and shortest recuperative period. Your browser may not support display of this image.Implants, however, require maintenance and may require replacement, possibly multiple times in the course of a patient’s life, particularly for capsular contracture (scar tissue hardening around the implant) and implant rupture or deflation.

At the time of the mastectomy and expander placement, some saline (salt water) is placed within the expander to begin the creation of the new breast mound. The expander, however, looks much less natural due to its design, than the more permanent implant that is later placed following expansion. Usually, at about one week after surgery, final drain tubes are removed and expansion is done in the office. Expansion is done at 1-4 week intervals depending upon patient comfort. Usually 3-5 expansions are done in the office and each takes about 5 minutes. Following each expansion, a feeling of tightness is usually felt for several days. Expansion continues until a size that appears pleasing is reached. Expansion can be done during chemotherapy and this is often the case. For those patients requiring chemotherapy, replacement of the expander with the implant can usually be done about one month after completion of chemotherapy.

While the initial mastectomy and expander reconstruction is done in the hospital, usually with a 1-2 night hospital stay, the subsequent stages are typically done as an outpatient. The expander tends to sit higher than the final implant. Therefore, at the time of the expander replacement with implant, the implant is re-positioned as appears appropriate. The opposite breast is often lifted and augmented, if desired, to improve symmetry. This outpatient procedure is done under general anesthesia administered by a Board Certified anesthesiologist. Approximately two months later the nipple(s) is made, usually shaping tissue on the chest wall to make the nipple and areola. A variety of nipple reconstructions exist and Dr. Orringer individualizes the technique to each patient. After healing of the new nipple(s) occurs, usually about 8 weeks later, medical tattooing is done in the office by Beverly Hills plastic surgeon, Dr. Orringer, in an effort to hide scars and improve realistic quality.

What are the Types of Implants?

All implants have a silicone rubber shell. Filler materials include saline (salt water) and silicone gel. Saline is the safest substance known since it is a natural material found within the body. However, silicone gel implants tend to look and feel more natural since the gel is more similar in consistency to the normal breast. Particularly in the early 1990’s, the question was raised whether there was a link between silicone implants and autoimmune disorders or other systemic diseases. Most studies did not support this. Silicone gel implants can now be used in women at least 22 years of age who opt for them. Dr. Orringer is an investigator of both Mentor and Inamed silicone implants. Cohesive gel implants contain a more solid silicone gel. These implants feel more firm than traditional gel implants. They are currently not widely available although clinical studies are on-going. Tear drop and round implant shapes are available. While sounding ideal, “tear drop” implants may rotate and must be textured. Therefore, they may not look as aesthetic as round implants. Implants come in a variety of sizes and profiles (degree of projection off the chest wall). Size and style are individualized to the patient’s body build and aesthetic desires.

You will hear of smooth and rough surface (textured) implants. Smooth implants tend to move in a more natural way and wrinkle less. Textured implants, however, in some studies stayed softer longer. Dr. Orringer currently prefers smooth implants for their softer feel, less wrinkling and more natural movement.

What are some special considerations with Expander and Implant Reconstructions?

Implant reconstructions are often selected because of their potential simplicity, shorter hospital stay and recuperative period. For many patients, it is a good choice. However, it should be realized that implants require maintenance, and may require replacement, possibly multiple times in the course of a patient’s life. Implants are most often replaced when firm scar tissue develops around the implant (capsular contracture) or because of implant rupture or deflation. Some patients’ implants will do well for 15 years and longer, while others will become firm, rupture or deflate in a much shorter period of time. Implant shells today are thicker and less permeable than they were prior to the late 80’s when many implant rupture studies were done. It is hoped that the implants will therefore maintain integrity and stay softer longer. Dr. Orringer is involved with a post FDA approval study of silicone gel-filled implants which is currently on-going. Implant reconstructions are not as natural in their feel and appearance as reconstructions done using one’s own tissues. However, scars are more limited with implant reconstructions. When the chest wall tissues are thin following mastectomy, implant edges and ripples are more visible unless the padding over the implant is improved. One common way to improve thickness over the implant is with the use of products such as AlloDerm and Flex HD. These grafts are up to 3mm thick and are derived from human skin. However, they are treated such that the old cells are removed from them and the patient’s own cells grow into the grafts.. They then, in essence, become another layer of one’s own tissue. This technique may decrease implant visibility and palpability. It has gained widespread use today and appears in many instances to improve the appearance of the implant reconstruction.