Breast Reconstruction after Mastectomy with Tissue Expanders or Breast Implants.
Most patients are candidates for this operation, which can be done in one or two stages, depending on your individual anatomy. When done as a two-staged operation, a temporary spacer called a tissue expander is placed in your breast pocket after the breast tissue is removed by your breast surgeon. The tissue expander looks like a deflated water balloon with a rubber port. The expander is partially filled with saline during the first operation and the incision is then closed with stitches. Over the next few weeks, the tissue expander is slowly inflated at your office visits until your desired size is obtained. Once you reach your desired breast size, you have your second stage surgery which involves removing the tissue expander and replacing it with a permanent saline or silicone gel implant.
When done as a one-stage operation, the breast implant is inserted directly into the skin envelope at the time of the mastectomy. You may discuss whether you are a candidate for one stage direct-to-implant reconstruction with your surgeon.
If you are a candidate for breast reconstruction, you are most likely a candidate for tissue expander-implant reconstruction. There are some exceptions, such as patients with inflammatory or very aggressive breast cancer, who should not have breast reconstruction. Implant-based reconstruction also has a higher risk of complications for patients who smoke or need radiation.
Before surgery, you will be placed under general anaesthesia. You will then undergo mastectomy , followed by immediate placement of the tissue expander or implant.
You will have drains in each operated breast and stay overnight in the hospital. Most patients complain of chest tightness after this surgery. You will be prescribed muscle relaxants that will help with the tightness.
Your surgeon will discuss specific instructions for this operation. You will need to empty your drains per day and record the output. This will let your surgeon know when the drains are ready to be removed. You cannot shower while your drains are in. Your drains will be removed in the office before your tissue expansions are started.
