Breast

This is based on several factors related to your current bra size, desired bra size, chest wall dimensions and how much breast tissue is removed at the time of your mastectomy. There are many different styles of implants with varying widths and projections to help re-create your breasts into a natural breast size and shape.

The implants are placed either above the chest muscles (pre-pectoral) or underneath the chest muscles (sub-pectoral). The decision to place the implant in one position over another is based on several patient related factors such as skin-tissue thickness of the chest wall, occupation, ability to tolerate motion of the implants while doing activities and need for post-operative radiation therapy.

A tissue expander is essentially a deflated breast implant that can be placed at the time of mastectomy or in a delayed procedure. The blood supply to the skin of the breast is primarily from the chest wall through the breast tissue itself which will be cut at the time of mastectomy, so time is needed to allow the blood vessels in the breast skin to grow in size and number, which takes time.

To allow the skin to heal properly and not place excess tension on these small skin blood vessels, a tissue expander can be used and slowly expanded over time to achieve the desired shape and volume. This is generally used if there is any concern with the skin flaps at the time of mastectomy, if you’d like your new breasts to be significantly larger, or if certain other conditions apply that will be discussed by your surgeon in the planning phase.

Traditionally, in a skin-sparing mastectomy a transverse or horizontal incision is used to remove the nipple and breast tissue through the middle of the breast mound. In a nipple-sparing mastectomy, a transverse/horizontal incision can be used as above or an incision in the crease at the bottom of the breast or inframammary crease can be used to remove the breast tissue while hiding the scar. The incision that is used is usually based on where your tumor is, the current/desired size of your breasts, and what your breast surgeon thinks is best from a cancer treatment standpoint.

Any time a space that is not naturally present in the body is created the body leaks fluid into that area until it can sufficiently heal. While the body can absorb a lot of the fluid, there is a limit to its capacity before it begins to accumulate in the space, which can lead to infection and other complications. Until the fluid production reaches a certain level, a drain is used to help prevent its accumulation and is important for this procedure.

Some patients stay overnight in the hospital to ensure their pain is well controlled but many go home the same day after mastectomy and implant-based reconstruction. Most of my patients describe a soreness in the lateral chest wall but have also described muscle spasms and electric-like pains that can vary in timing. Because the nerves to the breast skin are cut to remove the breast tissue, the breast skin is largely numb and insensate with many patients getting back some sensation over time.

You’ll be placed in a supportive/sports bra at the time of surgery and be asked to wear it continuously for the first 4-6 weeks to allow the implants to heal into their proper positions. You’ll also be asked to avoid any heavy lifting or overhead activities for the same period.

To give the incisions time to heal and allow the blood vessels within the breast skin to grow/enlarge, we wait 3 weeks before initiating breast tissue expansion with saline.

Once the expander is at its determined volume, the breast pocket/capsule is allowed to mature for 3 months before the tissue expander is removed and a permanent implant is placed.