Implant-Based Breast Reconstruction and Augmentation

Introduction

Breast reconstruction and augmentation is a surgical procedure that involves restoring the shape and form of the breast after mastectomy; caused due to cancer. Plastic surgeons and breast surgeons do this procedure. Both of them should cooperate for the greatest outcomes.

This procedure is done in two stages; sometimes, multiple operations may be needed. In this procedure, there is the usage of two types of implants one is silicon-based and the other saline implants. Breast reconstruction surgery and augmentation do not produce the exact natural shape and form of the breast but mimic the contour of the breast shape after a mastectomy.

What Are the Different Types of Implants for Breast Reconstruction and Augmentation?

Breast implants render a proper shape to the breast after mastectomy. Two types of implants are most commonly practiced for surgical reconstruction or augmentation.

These include,

1. Saline Breast Implants: These are more commonly used. In this type, implants are filled with sterile saline solution with an inner structure made in such a way as to render a more natural look and comfort for the patient.

2. Silicone Breast Implant: These implants are made of thick silicon gel and give a more natural appearance to the breast. These implants are firmer when compared to saline-based implants. Two types of surfaces are present; one is smooth, and the other is textured. Depending on the requirement, the surgeon will choose which is better.

How Is the Procedure Done?

There are two types of procedures involved in breast reconstruction. These include:

1. Immediate Reconstruction:

• 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.

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• 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.

2. Delayed Reconstruction:

• In this procedure, reconstruction is done a few months after the mastectomy.

• A tissue expander is inserted in the first phase under the skin, and a mastectomy procedure is performed after a few months.

• In subsequent visits, the tissue expander is filled with saline, so the skin is pulled along with the expander.

• Once the desired size is reached, the surgeon will perform the second stage of surgery, where an implant precedes the tissue expander.

3. Nipple Reconstruction:

• In this procedure, the nipple is reconstructed, and the areolar (dark region around the nipple) is tattooed to give a realistic look.

• This procedure is performed depending on the patient's interest.

What Are the Precautions to Be Taken by the Patient?

The procedure is usually performed under general anesthesia.

Before the Procedure:

• Before the procedure, patients are advised to quit smoking for at least two months.

• Before surgery, patients may be advised to stop blood thinning medications such as Aspirin, Clopidogrel, Vitamin E, and Warfarin.

• Patients are advised to take medications prescribed by the doctor.

On the Day of the Procedure:

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

• The procedure is performed under general anesthesia, so the patient is advised to come with an accompanying person to take care of her.

After the Procedure:

• The patient is discharged on the same day after the surgery or sometimes needs to stay one or two days in the hospital.

• Incision drains will be placed near the chest to collect the fluid.

• Postoperative pain will be there for a few days, which is typical.

• Follow the medications prescribed by the doctor.

• Patients can resume normal activities after six to seven weeks.

• Surgeons will advise restricting strenuous physical activities for life long.

• Recovery from surgery is usually long and may take more than a year to heal completely.

• Patients may be advised to have a screening mammography once every year if only one breast is reconstructed due to mastectomy.

• Mammography may not be necessary for young patients who underwent breast augmentation for aesthetic purposes.

• However, follow-up appointments are necessary to check for any shift, leak, or asymmetry in implants.

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.

What Does Breast Reconstruction and Augmentation Do?

• It increases the self-esteem of the patient.

• Gives a natural contour to breasts.

• Helps to avoid the usage of unnecessary physical or external prostheses inside the bra.

Conclusion

Breast reconstruction and augmentation help the patient to achieve a breast with proper shape and form. It allows the patient to improve their quality of life and well-being. However, it is tough to achieve a realistic look. Reconstruction of the breast may not restore the normal sensation to the nipple or breast area. Few people may require additional surgeries to complete the desired look.