When you wake up from surgery, you will either have a breast mound or be in the initial stages of creating a breast mound. There are 2 procedural possibilities if you elect to have immediate reconstruction with an implant: one-stage and two-stage breast reconstruction.
One-Stage immediate breast reconstruction is a procedure in which your plastic surgeon places a breast implant immediately after your general surgeon removes any cancerous breast tissue. Women who have had a nipple-sparing mastectomy (wherein the nipple is not removed), leaving the majority of the breast skin, may have the possibility of one-stage reconstruction.
Two-Stage immediate breast implant reconstruction involves a combination of procedures to gradually create a place in your chest tissue for the breast implant to occupy. Two-stage implant reconstruction using a tissue expander followed by placement of a permanent implant is the most common type of implant-based reconstruction and allows for the most flexibility in shaping the breast. In the first stage of the two-stage reconstruction process, an implant called a tissue expander is placed by your plastic surgeon after your general surgeon completes your mastectomy. This tissue expander is subsequently filled with sterile saline in an outpatient, clinic setting. Your surgeon will increase the volume in the tissue expander over time. This causes the surrounding tissue to stretch and eventually re-grow the skin that was initially removed with the mastectomy, allowing a surgeon to recreate a desirable breast shape. The tissue expander is finally replaced with a breast implant some months later.
One additional option is that your plastic surgeon may decide to place a dual function implant that is a combination tissue expander/breast implant. This dual function implant is filled with little to no volume initially. Fluid is then gradually added in a simple office procedure after your surgery - similar to with the process of filling a tissue expander. Once your desired breast size is achieved, the mechanism used to fill the implant is removed in the office. The dual function device ultimately serves as your permanent implant, avoiding any need for an additional operation to exchange the expander for the permanent implant.
Often the amount of skin remaining in the breast area after the mastectomy determines whether reconstruction with an implant can be performed in 1 or 2 stages. For example, a complete mastectomy removes the greatest amount of skin (of all the types of mastectomy) and will most likely necessitate the use of two-stage reconstruction. Your surgeon will discuss which type of implant reconstruction is best for you.
Potential Advantages of Immediate Breast Reconstruction (i.e. having reconstruction at the time of the mastectomy)
Potential Disadvantages of Immediate Breast Reconstruction Surgery
It is important to understand that any breast reconstruction surgery (with or without breast implants) may require multiple procedures. Your surgeon may also recommend a procedure that provides better symmetry or balance between your breasts. These symmetry procedures for the unaffected breast can include breast augmentation with an implant, breast reduction (reduction mammoplasty), or a breast lift (mastopexy).
You may additionally desire to have nipple reconstruction. These minor, outpatient procedures help recreate your pre-mastectomy breast appearance. A variety of different techniques are used for these procedures. You should discuss your options with your plastic surgeon for best results.
The exact number of procedures and estimated recovery times will vary for every woman. Your general surgeon, plastic surgeon, and oncologist should work together as a team to plan your individual reconstructive process. As a reminder, it is important for you to know that the Women’s Health and Cancer Rights Act, a federal law passed in 1998, ensures your right to have these types of symmetry procedures and nipple reconstruction covered by your health insurance provider.
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