Many implant-based breast reconstructions start with an adjustable temporary implant called tissue expander that helps create the pocket that will accommodate the final implant.
Implant reconstruction often begins at the same time as a mastectomy. Implant reconstruction may happen in one stage, known as direct to implant reconstruction, or two stages, beginning with an adjustable temporary implant called a “tissue expander”.
Tissue expanders are the most common method for implant reconstruction. At the time of mastectomy (or later in delayed reconstruction), a tissue expander is placed under the skin. This is because after a mastectomy there may be reduced blood supply to the skin and placing a full sized implant may further compromise the circulation resulting in skin loss. Over time, as circulation improves, more volume may be placed in the expander. In delayed reconstruction, there is frequently a deficit of available skin as any excess skin may have been removed at the time of mastectomy. In this case, the expander can be used to gradually stretch the skin to create a pocket to accommodate an implant.
Expansion usually occurs over the course of several visits, as fluid or air is injected into a port within the tissue expander, gradually stretching the skin. When the tissue expander has achieved a volume similar to the implant that will be placed, it is removed and then replaced with a permanent implant.
Direct to implant reconstruction occurs at the time of mastectomy without the use of a tissue expander. This option is possible if the breast skin is healthy enough and the pocket large enough to immediately accommodate an implant.
After placing the tissue expander, it is filled with additional saline solution every 1-2 weeks. On average, it takes 2-3 months for the tissue expander to achieve desired volume and a stable pocket to be formed. At that point, the permanent implant can be placed. This is usually done as an outpatient procedure.
For direct-to-implant reconstruction to occur, there must be enough healthy skin in the breast area to accommodate the volume of the new breast. For this reason, direct to implant procedures are often best suited for women who have, or desire, a smaller breast.
Although direct-to-implant reconstruction happens at the same time as a mastectomy, secondary procedures such as fat grafting or modification of the implant pocket may be necessary to optimize the cosmetic appearance of the breast.
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