In cases of so-called skin sparing mastectomies (removal only of glandular tissue, with no skin excision) it is possible to use the simplest method of reconstruction with implant insertion. In this procedure, a silicone prosthesis of the appropriate size is introduced into the cavity left behind. The implants used in our clinic are certified and approved for all of Europe.
The incision has already been determined by prior removal of the tumor or mammary gland, so that there will be no new scars (region of nipple or inframammary fold). The procedure is mainly used when careful excision of the breast gland is indicated. The implant can be replaced by autologous tissue at any time, should the result no longer be satisfactory.
Expander Insertion and Silicon Implant
However, when the breast is removed together with its skin, the remaining pocket is usually not ample enough for implant insertion. In this case, the resulting cavity must be expanded over the course of several months in preparation for the procedure. To achieve this a so-called expander prosthesis is introduced. After wound healing is complete (approx. three weeks) this is little by little filled up with saline solution to stretch the skin and fashion a new pouch. Since tissues will shrink somewhat later on, we aim for overexpansion before we replace the expander with the definitive permanent silicone prosthesis.
The advantage of this type of breast reconstruction is simplicity and short operating time. Disadvantages include slight wavy irregularities of the surface of the prosthesis ("rippling"), which due to skin thinness may become noticeable. Implant positioning below the pectoral muscle is better at concealing these irregularities, but does not provide any guarantee against "rippling" or encapsulation. However, since the prosthesis is a foreign body, problems caused by capsular fibrosis can develop even years after the operation. The shell formed around the implant can become so hardened that it compresses the implant and leads to unattractive deformations and even pain. Replacing the implant is often only a temporary solution.
If radiation therapy is planned, implant reconstruction should be avoided since radiation leads to increased incidence of capsular fibrosis. Other potential complications include swelling, inflammation, or persistent sensation of tension in the expanded skin. Nevertheless, after reconstruction with implants, all other methods of autologous tissue buildup remain possible options.
Important Short Facts regarding implant reconstruction
- Anesthesia: general
- Duration of OP: one to three hours
- Hospital stay: four to seven days
- Supportive bra: eight to twelve weeks
- Suture removal: after two weeks
- Drainage tube removal: one to five days
- Disability: approximately four to six weeks
- Sports prohibition: approx. eight to twelve weeks