Breast reconstruction with tissue expanders and implants in Washington DC is the most commonly performed procedure for breast reconstruction. This type of reconstruction requires two separate operations.
Immediate Reconstruction with Tissue Expanders
At the time of your mastectomy, Dr. Pittman will insert a tissue expander beneath your skin and pectoralis major muscle. The tissue expander is a silicone-based plastic balloon that can be filled (expanded) with saline to help stretch the muscle and remaining breast skin to the reconstructed breast size you want. In the fold of the breast, Dr. Pittman will often also insert an acellular dermal matrix (sheet made of specially treated human skin scaffolding), which acts as an internal bra or sling for the tissue expander. Use of this material allows better expansion of the lower portion of the breast and decreases the muscular pain during the expansion process.
The surgery takes about 1 hour for each side, following the mastectomy surgery. You will be in the hospital overnight and will most likely be able to go home the next day. This surgery will require placement of surgical drains to remove excess fluids from surgical sites immediately following the operation. In most circumstances, these drains will remain in for 1-2 weeks. You are likely to feel tired and sore for a week or two after reconstruction and take about 4-6 weeks to completely recover. Most of your discomfort can be controlled by pain medication and muscle relaxers.
Filling of the expander usually begins two weeks after your mastectomy. The tissue expander is filled (expanded) with saline (salt water solution) through a magnetic port located inside the expander. In clinic, Dr. Pittman or his nurse will periodically inject a salt-water solution into the port to gradually fill the expander over several weeks or months. Chemotherapy or radiation may be recommended to you by your oncology team following your mastectomy. If you have these treatments, they may delay the tissue expansion process.
The process continues until the tissue expander size is approximately the desired size. You may feel a sensation of stretching and pressure in the breast area during this procedure. After the skin over the breast has regained its shape, the expander will be removed in a second outpatient operation and a more permanent implant will be inserted. The nipple and the dark skin surrounding it (the areola) are usually reconstructed in a subsequent procedure.
The exchange of the tissue expander for a permanent implant takes about 1-2 hours for one side, longer for both sides. This surgery usually does not require placement of a surgical drain, and you can go home the same day as your surgery. You are likely to feel tired and sore for a week or two after the exchange. Most of your discomfort can be controlled by pain medication.
Permanent breast implants are silicone shells filled with either salt water solution (saline) or silicone gel. The permanent implant is much softer than the tissue expander. Saline implants have been approved for use by the Food & Drug Administration (FDA) since 1992. Prior to 1992, silicone implants were used routinely. In 1992, due to silicone leaking and fears that silicone implants could cause cancer or other diseases, the FDA removed silicone implants from the market. After 1992, large studies were conducted to check the safety of silicone implants. These studies showed there was no connection between silicone implants and cancer or other diseases.
In 2006, the FDA again approved the use of silicone gel breast implants. There are risks and benefits for undergoing breast reconstruction with silicone breast implants, and you will receive a detailed patient brochure to educate you on these. Be sure to discuss current options with Dr. Pittman. The alternative, a saline-filled implant, a silicone shell filled with salt water, is also available if you choose. Many of the risks are the same, when comparing silicone-filled versus saline-filled.
Both types on implants come in a variety of shapes and sizes. During the expansion process, you will have a visit with Dr. Pittman to specifically talk about which implants are best suited for you. Many times the choice of implant comes down to your desired goals for reconstruction.
Any time an implant is used, there is a small possibility that an infection will develop, usually within the first two weeks following surgery. In some of these cases, the implant may need to be removed for several months until the infection clears. A new implant can later be inserted.
The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard, sit higher on the chest, and appear smaller. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant. Radiation therapy dramatically increases the risk of tightness around the implant, due to the fact that it can cause progressive radiation fibrosis (radiation-induced scarring) in some patients.
About 8-12 weeks after exchange from tissue expander to the permanent implant, a nipple reconstruction can be performed. The nipple is created from small flaps of tissue on the breast. Following surgical creation of the nipple, a tattoo can be performed on the breast to recreate the pigmented color of the areola.