TYPE OF IMPLANTS
If the surgeon recommends an implant, it is important that the patient discusses with the surgeon on the type of implant to be used. A breast implant refers to a silicone shell that can either be filled with silicone gel or salt-water solution, also known as saline. Presently, there are concerns that there is inadequate information that demonstrates the safety of breast implants filled with silicone gel. As a result, the Food & Drug Administration (FDA) has decided that such implants should only be availed to women taking part in approved studies. Currently, this includes women already having tissue expanders or those who opt for immediate reconstruction following mastectomy. It also includes women who already have gel-filled implants and who need a replacement for medical reasons. Ultimately, all the women who have appropriate medical indications could have similar access to such implants.
However, the saline-filled implants are available without any restrictions.
There are many options which are available in breast reconstruction, thus the patient and the surgeon should settle on what is best for her. The most common surgery technique is referred to as skin expansion. After the mastectomy, the surgeon inserts a balloon expander beneath a person’s skin and chest muscle. Using a valve mechanism that is buried under the skin, the surgeon periodically injects salt-water solution into the expander, gradually filling it over several months or weeks. Once the skin over the patient’s breast area has stretched sufficiently, a second operation may be performed to remove the expander. Afterwards, an implant that is more permanent will be inserted. However, there are expanders that are designed to act as final implants. The nipple and the areola are usually reconstructed in subsequent procedures. Not all patients require tissue expansion prior to receiving an implant. In this case, the surgeon inserts an implant as the initial step.
Flap breast reconstruction is the other approach to implant reconstruction. It entails the creation of a skin flap, whereby the surgeon uses tissue that is taken from certain parts of the body such as the buttocks, abdomen or back. In one type of this form of surgery, the tissue remains in its original site, thus ‘preserving its blood supply. The flap, which consists of the skin, muscle, fat and blood supply, is tunneled beneath the patient’s skin to the chest. Such a flap may create a pocket for the implant, or it may create the breast mound without the need for an implant. The other flap technique utilizes tissue that has been surgically removed from the buttocks, thighs or abdomen. The tissue is then transplanted to a patient’s chest, through reconnecting its blood vessels to new ones in the region. This procedure requires a plastic surgeon who is also skilled in micro-vascular surgery. Regardless of the approach used, this form of surgery is more complicated than skin expansion. There will be scars both at the tissue donor site and reconstructed breast, while recovery takes longer than with implants. However, since the breast is entirely reconstructed with a person’s tissue, it has more natural results, while there will be no concerns regarding silicone implants.
In most cases, breast reconstruction involves several procedures that normally occur over time, whereby the initial reconstructive operation is usually the most complex. Follow-up surgery may be needed to replace tissue expanders with implants, or to reconstruct the patient’s nipple and areola. Most surgeons may recommend an additional operation, aimed at enlarging, reducing or lifting the patient’s natural breast in order to match with the reconstructed one. Patients should keep in mind that this procedure may leave scars on their normal breast, while it may not be covered by health insurance.