Implant-Based Breast Reconstruction

What is Implant-Based Breast Reconstruction?

Case #7522

There are several different options for breast reconstruction. Breast reconstruction following mastectomy can be performed using the patient’s own tissue (autologous reconstruction) or with breast implants, and sometimes a combination of both. Breast reconstruction can take place in a single surgery immediately following a mastectomy known as immediate reconstruction, or any time thereafter referred to as delayed reconstruction. Immediate breast reconstruction has the significant psychological benefit of a patient forgoing a period of time being without a breast mound. Sometimes though, for reasons related to a patient’s breast cancer, it may be preferable to delay breast reconstruction.

What is an implant-based breast reconstruction?

There are several techniques that can be used for breast reconstruction. The most common form of reconstruction involves the use of breast implants. In implant-based breast reconstruction, the use of tissue expanders and a 2-stage approach is most common. In this method, a breast implant (whether saline or silicone) is ultimately used to fill the space previously occupied by your natural breast tissue. This allows patients to maintain their feminine appearance in clothing and remove the constant reminder of breast cancer.



What are the benefits of an implant-based breast reconstruction?

Implant-based breast reconstruction has less downtime and an easier recovery compared to other forms of post-mastectomy breast reconstruction. Patients are able to have a significant amount of control over the size of their reconstructed breasts, and can have excellent cosmetic outcomes. Symmetry can be particularly good in patients who are undergoing implant-based reconstruction for both breasts.

What are the limitations of an implant-based breast reconstruction?

Breast implants are not expected to be life-time devices, and require maintenance. After about 10-15 years, the risk of issues related to a patient’s implant increases, and implants may need to be exchanged. Furthermore, in patients who have a prior history of, or anticipated need for, breast radiation, implant-based breast reconstruction has a greater complication profile. Radiation tends to increase the risk of infection and decrease the aesthetic result. Obtaining excellent symmetry can be challenging in patients who are only having a mastectomy on one breast and have no intention in having balancing procedures on the unaffected breast. Implants also are made in pre-designated sizes, so patients with very large breasts may not be able to obtain their pre-mastectomy size with an implant alone.



Am I a good candidate for an implant-based breast reconstruction?

Breast reconstruction is always an elective procedure, and therefore a patient needs to be an appropriate candidate from a medical perspective to undergo any form of reconstruction. Having significant medical comorbidities, such as obesity, diabetes, heart disease, pulmonary disease, etc. can result in a patient being a poor candidate for reconstruction.  Smoking is also a significant risk factor in implant-based reconstruction, as it increases the risk of wound healing problems and infection. If a patient is healthy enough to have reconstruction, and they do not have a prior history of radiation, they can be a good candidate for an implant-based breast reconstruction.  Patients who have a prior history of radiation can still undergo an implant-based breast reconstruction, but these patients typically also require a more extensive procedure such as a latissimus flap to help decrease the complication risk resulting from prior radiation.

How is an implant-based breast reconstruction performed?

When performing an implant-based breast reconstruction, our board-certified plastic surgeons insert a temporary implant either above or below the chest wall muscles, typically at the time of the mastectomy. Often a dermal-mesh will also be used to support the expander and breast skin. After an overnight stay in the hospital, patients are discharged home and over several weeks in the comfort of the office, saline is injected into the expander, stretching the breast skin to create a pocket (or space) for a permanent breast implant. Once the desired size is achieved, the expander is removed and replaced with an implant as an outpatient procedure. Other procedures can be combined with this second stage, such as fat-grafting to improve contours, or procedures for the opposite breast if needed for symmetry.



What is an implant-based breast reconstruction recovery like?

Patients will typically spend one night in the hospital after their mastectomy and placement of a tissue expander for implant-based breast reconstruction. They will have surgical drains in the breast that will need to be taken care of. These drains are typically removed within 1-2 weeks after surgery, depending on fluid output. Particularly when the expander is placed above the chest wall muscles, the recovery from this surgery is typically well tolerated. The expected recovery time is approximately 4 weeks.  The exchange of a tissue expander to a permanent implant is performed as an outpatient surgery, where you go home the same day. This exchange has a quick recovery period with a minimal amount of downtime.

What will the scarring look like?

Scarring patterns can vary significantly in implant-based breast reconstruction. Scars can depend on the shape and size of a patient’s breast prior to mastectomy, as well as factors involving their cancer – such as if a patient is a candidate for a nipple-sparing mastectomy. Our board-certified plastic surgeons will go over the details of each patient’s particular anatomy to help achieve the best possible aesthetic outcome and the least scarring.



Can my unaffected breast be addressed to improve symmetry?

Yes! As a part of the 1998 Women’s Health and Cancer Rights Act, healthcare insurers must cover any surgery needed to the unaffected breast (i.e. lift, reduction or augmentation) to obtain symmetry in women who have undergone a mastectomy.

Will insurance cover my implant-based breast reconstruction? 

Breast reconstruction is not only an option, but a right, for women seeking to rebuild one or both breasts following surgical treatment of breast cancer, including lumpectomies and mastectomies. These surgical services are typically covered by insurance as the 1998 Women’s Health and Cancer Rights Act specifies that healthcare insurers must cover breast reconstruction following mastectomy. It also stipulates that any surgery needed to the opposite breast (i.e. lift, reduction or augmentation) to obtain symmetry will also be covered.



Why should I have my implant-based breast reconstruction performed at Samra Plastic Surgery?

Our team of board-certified plastic surgeons have trained at the best programs in the country, including the top cancer hospitals, and are very experienced in performing this type of breast reconstruction at a high volume. We will work closely with your breast surgeon who is performing the mastectomy to give you the best possible outcome and maximize your patient experience.



Contact us to set up a personal or virtual consultation with one of our board-certified plastic surgeons today.