Breast Reconstruction with Implants
Implant based breast reconstruction is the simplest method of reconstructing the breast. It is suitable for women who do not wish to have a complex method of reconstruction that uses their own tissues. One of its main advantages is that it avoids scars in other part of the body such as the scars resulting from a DIEP or an LD flap reconstruction.
An implant based reconstruction is contraindicated in patients who have had previous radiotherapy as part of their breast cancer treatment as the tissues lose their elasticity following radiotherapy and the result of the reconstruction is likely to be suboptimal.
In most cases a minimum of two surgical procedures are required for the reconstruction to be completed. In the first procedure an expander is inserted under the chest wall muscles and skin. The expander is a silicone shell device connected to a tube and an injection port. The expander can be inflated with normal saline injected via the port in the outpatient clinic and stretches the overlying muscle and skin. During the second operation the expander is exchanged with a fixed volume silicone implant. This gives a breast-like shape and form to the reconstruction. Complications specific to implant based reconstruction include exposure and infection of the expander or the implant if the surgical wound breaks down in the immediate pot-operative period or if the skin thins out excessively during the expansions. In these cases the implant usually requires removal thus resulting in loss of the reconstruction. A late complication of implant based reconstruction is development of thick scar tissue around the implant (capsular contracture) causing distortion of the shape and the form of the reconstructed breast and discomfort to the patient. This often requires a further procedure to remove the capsular tissue and insert a new implant.