Microsurgery isn’t required, so the operation takes less time and the recovery time is usually shorter.
Implant reconstruction, like natural tissue reconstruction, can be done at the time of the mastectomy, or it can be started at that time and completed later. Implant reconstruction may require additional surgery in the future, as implants are recommended to be changed out after 10-20 years, depending upon the type of implant used.
Implants may be a good option for thin women who do not have enough extra tissue on their bellies, backs, thighs, or buttocks to consider natural tissue reconstruction. However, some of the newer advanced microsurgical procedures such as stacked flaps (using multiple layered flaps) and hybrid reconstruction (using natural tissue with an implant) have begun to address this challenge in thin women who still wish to use natural tissue for their breast reconstruction.
There are a number of factors you need to understand and consider as you and your surgeon decide which type of breast reconstruction is best for you.
Implants come in a range of sizes (overall breast volume) and profiles (how much an implant projects forward from the breast wall while standing). Your plastic surgeon will learn your personal preferences and help you choose an implant size and profile that gives you the best aesthetic outcome.
Implant breast reconstruction may be done at the time of the mastectomy without first implanting a tissue expander. This is called direct-to-implant (DTI) reconstruction. This technique is usually used for smaller breast reconstructions and still may require additional procedures to optimize the aesthetic outcome.
If the skin at the breast site needs to be stretched before an implant can be put in, then a tissue expander ( an adjustable implant with a built-in port to inject air or fluid) is first inserted to prepare for a later implant. An expander may also be used if there is concern about blood supply to the skin to prevent tension or weight on the skin until it has healed. Because expanders have tabs that can secure them in position, they may also be used to better position the implant pocket prior to placing the final implant. This technique is called two stage or expander- implant reconstruction.
Implant reconstruction can also be done well after the mastectomy, called delayed implant reconstruction, and almost always requires initial placement of a tissue expander before placing the implant.
Due to the rising concern over the association of certain types of textured implants with an increased risk of BIA-ALCL, a type of non-Hodgkin’s lymphoma (cancer of the immune system), the U.S. Food and Drug Administration has requested a box warning on implant packaging for textured breast implants. Although the risk of developing BIA-ALCL is thought to be low, occurring in less than 0.03% of patients, this could potentially be a serious condition if not diagnosed early or not treated promptly.
Breast implant manufacturer, Allergan, has notified the FDA that it has recalled its BIOCELL textured breast implants and tissue expanders from the global market. These products have the same BIOCELL textured surface (shell), which is a unique surface used only by Allergan. Our office has taken extreme caution and no longer uses these types of textured implants. If you have already had breast reconstruction and are unsure if you have these types of implants, call your physician. If you currently have BIOCELL textured implants, you may be a candidate for revision surgery.
Recovery time for implant reconstruction is usually shorter than that for flap reconstruction. You’ll probably be able to go back to your usual activities in about 4-6 weeks. If you have a tissue expander removed and replaced with a permanent implant, recovery will take about 2 weeks.