Implant reconstruction has evolved with the addition of implantable collagen sheets. This material serves to support the implant internally much like a bra supports a natural breast externally. This allows for more stable placement and shaping. Consumers should be aware that they may need their implants replaced over time.
Implant reconstruction may be considered for those who do not wish to pursue natural tissue reconstruction. Use of implants to restore breast volume is an option for carefully selected patients. Better candidates are those with C cup or less breast volume, thick skin, non-smokers, and those with early breast cancer or need for prophylactic mastectomy. Those who may/will require radiation therapy are considered poor candidates for implant reconstruction as the occurrence of significant capsular contracture is very nearly assured.
Implant reconstruction is preferentially performed with a fully preserved skin envelope as provided with a skin and/or nipple-sparing mastectomy. This avoids the need for expander placement and a separate surgery to exchange the expander to a permanent implant. This type of procedure is the latest advancement for those seeking implant reconstruction and is often called a “One Step Implant Reconstruction” although, at the Center for Restorative Breast Surgery, we believe it is more properly referred to as an Alloderm Assisted Implant Reconstruction. This procedure allows for placement of the final implant at the time of mastectomy. The implant is placed under the pectoralis muscle and supported from below with a sling of collagen sheeting known as Alloderm. This provides added coverage for the implant and relieves the skin envelope of the burden of the implant’s weight.
Careful counseling is important since implant reconstruction differs substantially from the more familiar breast augmentation. The biggest challenge with implant reconstruction is that breast implants were designed to make healthy breasts larger not to rebuild an entire breast. So, they are affected by the same issues that affect any artificial device that is used to replace a part of the body. These devices, whether they are artificial joints, heart valves, or breast implants are subject to wear and failure over time. In the case of breast implants, this usually means a deflation or silicone leak that is addressed with a surgery to replace the implant. Rarely, infections can form around breast implants requiring their removal. Patients should expect the implant to be more palpable than is typical for a routine breast augmentation. Capsular contracture is the most common complication after implant reconstruction and occurs in between 30 and 90+% percent of cases. It is the formation of scar around the implant that makes the breast firm and in worst cases misshapen and painful. Your individual risk is unpredictable except for those who undergo radiation treatments who will nearly all develop it to a significant degree.
Breasts reconstructed with implants also have a tendency to move and distort shape when flexing the chest muscle. This isn’t harmful to the breast but is something that should also be anticipated. Watch Video here.
Making an informed decision for those who are proper candidates can lead to a very successful implant reconstruction when combined with a skillfully performed mastectomy for those with breast cancer or need for prophylactic mastectomy.