RECONSTRUCTION WITH IMPLANT/EXPANDER

The term “breast reconstruction” is used to describe the surgical procedure aiming to restore the shape, size, and overall appearance of the female breast after partial or total mastectomy. The ultimate goal of the surgery is the creation of a new breast, symmetrical with the contralateral healthy breast.

In recent decades, breast reconstruction has been considered an integral part of the comprehensive treatment, within the framework of an integrated treatment of breast cancer. Many centers regularly proceed to immediate breast reconstruction, that is, at the same time of the mastectomy. Therefore, the patient “wakes up” from the operation with a new breast, having been spared the experience of losing her breast.

One of the simplest and oldest techniques is the placement of silicone implants beneath the pectoralis major muscle. The operation is technically easy and it is recommended only in cases of immediate reconstruction and when it is not followed by radiation therapy. The implants, depending on their size, can create satisfactory symmetry with the contralateral breast, provided that the healthy breast is not ptotic. The disadvantages of implants are that they look unnatural compared to the contralateral breast, while sometimes, as a late complication, there can be shrinkage of the implant due to capsular contracture. Corrective surgery is often also required to the contralateral breast in order to achieve symmetry. In case of postoperative radiation therapy, there is a risk for the skin to “burn” and the silicone implant to be exposed. Therefore, this method is not indicated in these cases.

Tissue expanders are special silicone “bags” of appropriate shape and form, which are placed beneath the skin and are gradually inflated with saline infusion through a valve. They can be placed either simply beneath the skin and the pectoralis major muscle or beneath back tissue (latissimus dorsi myocutaneous flap) transferred to the mastectomy area. As the expander gradually fills, its volume increases and chest skin is stretched. A new breast is thus created. After the completion of the expansion, the new breast is not normally ptotic, as the natural contralateral breast. As a result, a corrective operation to the contralateral healthy breast is often required. The disadvantages of this method are the regular (every two weeks) visits to the Plastic Surgeon, in order to add saline to the expander, the possible need for a second surgical operation so as to swap the expander with a permanent silicone implant, and, in rare cases, the risk of the expander being exposed after postoperative radiation therapy. This method is mostly preferred for immediate breast reconstruction.