Implant Based Breast Reconstruction After Mastectomy
Breast reconstruction after mastectomy for cancer may be performed immediately at the time of mastectomy or as a delayed procedure several years after the mastectomy. Implant based breast reconstruction involves using silicone gel implants to reconstruct the breast. Other methods of reconstruction use the patient's own tissue, usually obtained from abdomen, to rebuild the chest.
Immediate Implant Based Breast Reconstruction
The latest methods of mastectomy and implant based recovery in selected patients involves sparing the entire chest skin, including nipple areola, and reconstructing breast immediately in one or two stages depending on the size. In small breasts a permanent silicone implant may be used to reconstruct the breast at the time of mastectomy. For larger breasts the recovery is done in two stages, first inserting a tissue expander, followed several months later by replacing the expander with a permanent silicone gel implant. Patients who are to undergo postoperative chemotherapy or radiation therapy wait up to six months before having the expander exchanged for a permanent implant. Ideally the oncologic surgeon and the plastic surgeon work together to perform mastectomy and reconstruction.
Delayed Reconstruction With Skin Flap And Silicone Gel Implant
Patients who have undergone a modified radical mastectomy without reconstruction may have a delayed recovery using their own tissue and a silicone implant. Because of lack of skin in the front chest wall after a modified radical mastectomy, additional skin and muscle is moved from the back to the front to reshape the breast. A silicone gel implant is inserted at the time of flap transfer to add volume to the breast. This procedure is known as a latissimus flap reconstruction, the latissimus being the muscle that is moved from back to front.
If the nipple-areola has been removed at the time of mastectomy, it may be reconstructed 6 months after the completion of the breast reconstruction. This is done by first reconstructing the nipple with the patient's own tissue followed several months later by tattooing areola / nipple.