Surgical Procedure
The simplest method of breast reconstruction following a mastectomy is the insertion of a breast implant beneath the chest muscles (Pectoralis and Serratus ) and overlying skin to create a breast mound. In order to accommodate an implant, the muscles and skin must be stretched slightly larger than the natural breast over several months, following the mastectomy with the use of a device called a tissue expander. This is a silicone shelled sac that is serially inflated with normal saline (salt water) every 2 weeks until the desired size is achieved. Once the expander is inflated and the selected breast size has been achieved, the expander is removed and the breast implant is inserted. This can be comprised of either silicone or saline. This is done as a separate operative day care procedure. More info on Breast Implants. |
Dr. Van Laeken prepares the implant in the operating room. |
The nipple reconstruction will follow several months after the patient has healed from this exchange procedure.
Finally, a tattoo of the aerola is performed to complete the process.
Occasionally, a balancing procedure is recommended for the unaffected breast to create greater symmetry. Typically, this involves a breast lift or reduction.
Below is a list of the operative procedures required to complete the breast reconstruction with an implant:
Immediate Reconstruction (3 operative procedures in total)
1. Mastectomy and insertion of tissue expander (in hospital 1-3 days)
- Follow up appointments required for tissue expansion at your surgeon’s office, commencing 1 month post op, every 2 weeks for approximately, 3-4 months.
- Once Dr. Van Laeken is satisfied that the desired volume is achieved, you will be appropriately sized for your implant and placed on the O.R. waiting wait list.
2. Removal of tissue expander and insertion of breast implant (daycare procedure)
- Occasionally, a balancing procedure is recommended for the unaffected breast to create greater symmetry overall. Typically, this involves a breast lift or a reduction.
- Dr. Van Laeken recommends 3 months to heal from this procedure before proceeding to the nipple reconstruction phase. Typically, you are able to return to work in a week. After the breast mound settles into place, plans are made to rebook the patient for the nipple reconstruction. This part of the procedure is not done at the time of the exchange as the position of the breast mound takes time to settle, thereby altering the final position of the nipple if done simultaneously. Consequently, the location would be potentially lower than intended. Patience produces the most aesthetic results.
3. Nipple and areola reconstruction (daycare procedure)
- To the operating room for the nipple aerola reconstruction: the graft is taken from the skin on the side of the breast or from the lower abdomen/groin.
- Healing time is 3 months, prior to proceeding to the tattoo.
- Tattoo of nipple and areola (outpatient procedure).
- The areola/nipple is matched with the appropriate skin tone pigments and tattooed for permanent results. This is performed at St. Paul’s hospital as an outpatient procedure. This is the final stage of the reconstruction
Delayed Reconstruction (4 operative procedures in total)
1. Mastectomy (in hospital 1-3 days)
2. Insertion of tissue expander (in hospital 1 day or daycare procedure)
- Follow up appointments required for tissue expansion at your surgeon’s office, commencing 1 month post op, every 2 weeks for approximately, 3-4 months.
3. Removal of tissue expander and insertion of breast implant (daycare procedure)
- See Immediate Reconstruction #2 explanation.
4. Nipple and areola reconstruction (daycare procedure)
- See Immediate Reconstruction #3 explanation.
- Tattoo of nipple and areola (done as outpatient procedure).
- See Immediate Reconstruction explanation above.
Potential Complications of Surgery
- infection
- bleeding
- seroma
- delayed wound healing
- scarring
- capsular contracture
- implant displacement/rupture
- thinning of the skin
- breast asymmetry
- DVT/PE
- implants are not considered a lifetime device and may need to be replaced at some point
- anesthetic associated problems