Immediate Breast Reconstruction With Implants in Conservative Mastectomies

Introduction

Following the indisputable proof of its oncological safety and the accessibility of trusted reconstruction techniques, immediate breast reconstruction following surgery has increased over the past ten years. In general, it is used in managing treatment failure following breast-conserving surgery and radiotherapy, after preventative mastectomy in high-risk patients, and in treating breast cancer. Many autogenous tissue treatments or prosthetic devices can be used to restore the breasts immediately.

What Are Factors To Be Considered for Immediate Breast Reconstruction In Conservative Mastectomies?

• Radiation: Certain outcomes in breast reconstruction seem to be adversely affected by radiation. Although radiation does not seem to raise the rates of serious complications, it does lead to poor cosmesis. When exposed to radiation, flaps have a higher rate of fat necrosis. When radiotherapy is necessary after reconstruction, there are difficulties. So it has been proposed that delayed-immediate reconstruction can be utilized to balance aesthetic outcomes with the capacity to deliver the best radiation.

• Chemotherapy: Chemotherapy regimens, both neoadjuvant and adjuvant, have been studied in the context of postoperative problems following mastectomy (removal of breast) and breast reconstruction. In patients receiving post-mastectomy expander or implant breast reconstruction, including those with tissue expansion concurrently, it appears that chemotherapy does not increase the likelihood of problems or implant failure.

• Hypertension: Hypertension was discovered to be an independent risk factor for perioperative problems. Patients who needed medical treatment were labeled as having hypertension in this series. The danger was estimated to be two times higher than in a patient with normal blood pressure. The likelihood of early tissue expander removal and explanation in hypertensive patient was four times higher.

• Diabetes Mellitus: Diabetes and implant infection have not been linked in any meaningful ways. Diabetes has not been proven to be a risk factor for postoperative complications or reconstructive failure. However, it is still encouraged that patients with breast cancer try to control their blood sugar during the time before surgery.

• BMI (Body Mass Index): Obese patients are almost twice as likely to experience a perioperative problem. People who are obese have seven times higher risk of therapeutic failure than patients who are not obese. Although their risk is noticeably lower, patients who are overweight, defined as having a BMI of 25 or more, are nevertheless more likely to experience postoperative problems and reconstructive failure.

• Age: Age does not appear to be a significant predictor of reconstructive failure, although it may be a risk factor for complications.

How Is Immediate Breast Reconstruction With Implants in Conservative Mastectomy Done?

With the option of executing an immediate repair and saving the outer layer of the mammary gland, conservative mastectomies remove the entire breast tissue while preserving the women's body image.

Anesthesia:

• Patients should stop eating or drinking at least six hours before the procedure.

• General anesthesia is preferred for the surgery, so the patient is advised to accompany a person to take care of her.

• The process usually takes one to two hours to perform, depending on the type of procedure.

Surgical Procedure:

• This procedure starts with a mastectomy (a procedure done to remove one or two breasts, to prevent the spread of cancer). This procedure is done in two stages.

• In the first stage, a tissue expander is placed under the skin or muscle of the chest during the mastectomy.

• The water balloon is initially flat and expanded till the desired size and shape are reached during follow-up visits.

• These tissue expanders are filled with saline through a tiny valve and expanded slowly at regular intervals to reach the desired size and shape.

• Mesh is sometimes used to hold the tissue expander.

• In the second stage, the surgeon removes the tissue expander and replaces it with a silicon or saline implant.

• The second stage of surgery can be postponed if there is a need for chemotherapy after mastectomy.

• A direct implant procedure can be done for younger patients with smaller breasts with no other health issues.

• In this procedure, there is no need for a tissue expander; the surgeon removes the breast tissue and places an appropriate implant to reconstruct the desired size and shape of the breast. Mesh is used for holding the implant in a place like a sling.

What Precautions to Be Taken for Postoperative Care After Surgery?

• Once a patient gets home, the surgery site should be kept dry and clean. They will receive particular bathing instructions from their doctor.

• If adhesive strips were applied, it is best to keep them dry. They frequently disappear after a few days.

• The intensity of pain will differ depending on how much tissue is removed during surgery and where it is removed. Over time, the soreness should lessen.

• Patients are advised to take medications as recommended by the doctor.

• Aspirin and a few other painkillers may make patients more likely to bleed. Make sure only to take prescribed medications.

• The doctor might advise you to continue wearing a bra for support.

• In two weeks, patients will probably resume regular activities. Avoid doing anything physically demanding in the interim. Avoid activities that require the use of the arm excessively, such as prolonged window washing or vacuuming.

• The doctor will examine and let the patient know when they can resume driving and working.

• Radiation therapy could be administered after surgery. Regarding this, the doctor will provide advice based on the patient's circumstances.

What Are the Risks Associated With Surgery?

• Severe bleeding at the surgical site.

• Infection at the site.

• The implant may break or leak. If this happens, the patient may require one more surgery.

• Due to distortion, the implant may shift.

• Asymmetry of the breasts, one breast is more significant than the other.

• Loss of sensation.

• Formation of scar around the implant resulting in pain and discomfort.

Conclusion

Immediate breast reconstruction is a secure and acceptable operation; there is no indication that it has unfavorable oncological effects. It can be accomplished with prosthetic or autogenous tissue repair in the right patient. The correct patient should be chosen to treat cancer while improving quality of life, minimizing problems, and optimizing results.