Implant Reconstruction to Restore Your Body Image

Breast implant reconstruction is probably the most common type of reconstruction for patients who are undergoing mastectomy. Breast implant reconstruction is usually a two-stage procedure where the patient undergoes two operations: one at the time of the mastectomy and then one a few months later. We use a breast implant to replace the tissue that is taken out during the mastectomy. Usually the skin of the breast is left behind and I like to think of this as kind of taking a pillow out of a pillow case. You can come and put a new pillow inside the pillow case and it looks like a normal pillow, and that's the same for a breast. The breast surgeon takes out the breast tissue but leaves behind the skin. My job is to come and fill that with something, that can either be a breast implant or it can be your body's own tissue. If I put in a breast implant, the breast implant has to be protected from the outside world. The skin that's left behind after mastectomy is very thin, so the implant has to go in underneath the muscle of the chest wall. Except that there isn't room underneath the muscle of the chest wall, so usually we do a two-stage operation where on the first day we put in something like a breast implant, called a "tissue expander." The tissue expander goes in underneath the muscle, you close up the skin, and when the patient wakes up from the operation, their breast is not the full size that it will be when we're all done with the reconstruction. They come back to the office and over the course of a few weeks or a couple of months, we expand the tissue expander by injecting it with saline. Once we reach the size of the breast zone that they're happy with, or the size that looks good for them, or the size that matches their other breast, then we schedule them for a second operation. We go back to the operating room and we take out the tissue expander and put in a permanent breast implant. And the breast implant can be made out of saline or it can be made out of silicon. There are plusses and minuses to each one. Most women get silicon breast implants for reconstruction, because it feels a little bit more natural and it looks a little bit more natural, but saline is certainly an option.