Breast Reconstruction Surgery – What to Expect During the Procedure

 

  

Depending on how you healed and how much breast tissue and skin is available to facilitate your breast reconstruction, your surgeon may decide that carrying out the breast reconstruction in several stages with an implant is the best option for you.

 

For women with less breast tissue and skin, the first stage of breast reconstruction surgery is inserting a tissue expander to help stretch out the skin and tissue to accommodate the breast implant. An expander is an inflatable silicone balloon-type device that is gradually filled with a saline (salt-water) solution, thereby stretching the skin, similar to what occurs naturally to your abdominal skin during pregnancy. This creates the room needed for the permanent implant to be inserted. Some months later, the expander is surgically replaced by the breast implant itself.  If you have ample breast tissue to cover the implant and healthy, supple skin coverage, your doctor may surgically insert a breast implant without the need to stretch your skin with an expander first.

 

Stage 1. Insertion of the Tissue Expander

 

The expander is usually inserted behind the greater pectoralis muscle and is then regularly filled with a saline solution through a valve called a ‘port’. This port is an integral part of the expander itself. Filling is done with a fine needle, directly through the skin and is usually painless. Some patients may experience a slight feeling of tightness in the breast, but usually this quickly passes. With the aid of this procedure, the skin is gradually stretched.

 

While the regular filling of the expander does not involve much physical stress, it does make demands on your time and involves two operations.  You should also be aware that some tissue expanders contain materials which are not compatible with MRI (magnetic resonance imaging). Please discuss this with your surgeon should you have any concern.

 

Stage 2. Insertion of Implant

 

Approximately 3 to 6 months after the first operation, when optimum skin expansion has been achieved, the tissue expander can be replaced by the permanent implant. Depending on your overall breast health and treatment plan, the time between the first and second surgery may be prolonged significantly by follow-up therapy. The surgeon will help you to choose the permanent implant to match your desires and remaining breast. In addition, you may be offered surgical adjustment to your remaining healthy breast to achieve the best outcome.

 

Breast reconstruction surgery is usually performed under general anaesthesia. All anaesthetics carry a risk, so you should discuss these risks with the anaesthetist. The surgery usually lasts between 1 and 2 hours.

 

The procedure to insert the new breast implant involves creating a pocket for the implant. After the pocket is created, the breast implant is placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the glands (subglandular). Once the implant is placed, the incision is closed with stitches. In addition to stitches, it may also be taped.

 

For some women, the option of an expandable breast implant, which combines the functions of both the expander and the breast implant, is also available, and requires only one operation. This implant is composed of two parts: one part is filled with a saline solution, the other with silicone gel. This implant will act as both the expander and the permanent implant: In this case the port is located under the skin and is attached to the expandable implant via a length of tubing. When the right breast size has been achieved (by the addition of the saline solution), the implant does not need to be removed.

 

Stage 3. Nipple and Areola Reconstruction

 

In a mastectomy, the nipple is removed if there is any possibility that is may contain cancer cells.

 

Once your initial reconstruction procedure is complete, the reconstruction of the nipple and areola of your breast may be performed as a separate surgery.

 

The nipple can be reconstructed in any of the following ways:

 

  • By raising the skin of the reconstructed breast, to create a little ‘button’

 

  • With the aid of skin from the nipple on the other breast, provided that it is big enough 

 

  • By using a section of skin from the thigh, ear, or toe

 

  • By inserting a piece of cartilage from the ear or rib under a small skin flap.

 

The areola (the darker skin around the nipple) can usually be reconstructed by tattooing, or, on occasion, with the aid of a section of skin from the groin or labia, since the skin is somewhat darker in these areas and resembles that of the areola.

 

In each case, the operation involved is minor and relatively painless. Operations to reconstruct the nipple and areola are carried out only when breast reconstruction has been completed. An important point to note is that reconstructed nipples usually have no sensation.

 

Next: After Your Procedure

 
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