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Breast Reconstruction

Surgery

Immediate Reconstruction with a Breast Implant

One-Stage

One-Stage immediate breast reconstruction is a procedure in which your plastic surgeon places a breast implant immediately after your general surgeon removes any cancerous breast tissue. Women who have had a nipple-sparing mastectomy (wherein the nipple is not removed), leaving the majority of the breast skin, may have the possibility of one-stage reconstruction.

Two-Stage

Two-Stage immediate breast implant reconstruction involves a combination of procedures to gradually create a place in your chest tissue for the breast implant to occupy. Two-stage implant reconstruction using a tissue expander followed by placement of a permanent implant is the most common type of implant-based reconstruction and allows for the most flexibility in shaping the breast. In the first stage of the two-stage reconstruction process, an implant called a tissue expander is placed by your plastic surgeon after your general surgeon completes your mastectomy. This tissue expander is subsequently filled with sterile saline in an outpatient, clinic setting. Your surgeon will increase the volume in the tissue expander over time. This causes the surrounding tissue to stretch and eventually re-grow the skin that was initially removed with the mastectomy, allowing a surgeon to recreate a desirable breast shape. The tissue expander is finally replaced with a breast implant some months later.

Additional Option

One additional option is that your plastic surgeon may decide to place a dual function implant that is a combination tissue expander/breast implant. This dual function implant is filled with little to no volume initially. Fluid is then gradually added in a simple office procedure after your surgery - similar to with the process of filling a tissue expander. Once your desired breast size is achieved, the mechanism used to fill the implant is removed in the office. The dual function device ultimately serves as your permanent implant, avoiding any need for an additional operation to exchange the expander for the permanent implant.

Often the amount of skin remaining in the breast area after the mastectomy determines whether reconstruction with an implant can be performed in one or two stages. For example, a complete mastectomy removes the greatest amount of skin (of all the types of mastectomy) and will most likely necessitate the use of two-stage reconstruction. Your surgeon will discuss which type of implant reconstruction is best for you.

Potential Advantages of Immediate Breast Reconstruction

  •  You may find it easier to cope with the mastectomy knowing that you will wake up with a breast mound - either a completely reconstructed breast or well into the process of restoring your breast.
  • You may save money, spend fewer days in the hospital, and have fewer days recovering from surgery when you combine the beginning of your reconstruction surgery with your mastectomy procedure.
  • You may have the potential for a one-stage breast implant reconstruction (because the breast skin is preserved), instead of the two-stage process that is necessary for delayed reconstruction (because delayed reconstruction occurs after the mastectomy and after the breast skin has contracted and lost its shape).

Potential Disadvantages of Immediate Breast Reconstruction

  •  The initial operative time and recovery period may be longer when breast reconstruction is performed in conjunction with your mastectomy.
  • There may be a higher risk of complications occurring after surgery if other treatments, such as radiation therapy, are combined with reconstruction. These complications could include, but not limited to, infection, opening of the incision, and capsular contracture (scar tissue forming around the implant). These complications are associated more with the use of adjuvant therapy (particularly radiation therapy) than with the timing of reconstruction (immediate vs. delayed). Your surgeon can assess whether or not you are at a higher risk for these complications.

It is important to understand that any breast reconstruction surgery (with or without breast implants) may require multiple procedures. Your surgeon may also recommend a procedure that provides better symmetry or balance between your breasts. These symmetry procedures for the unaffected breast can include breast augmentation with an implant, breast reduction (reduction mammoplasty), or a breast lift (mastopexy).

You may additionally desire to have nipple reconstruction. These minor, outpatient procedures help recreate your pre-mastectomy breast appearance. A variety of different techniques are used for these procedures. You should discuss your options with your plastic surgeon for best results.

The exact number of procedures and estimated recovery times will vary for every woman. Your general surgeon, plastic surgeon, and oncologist should work together as a team to plan your individual reconstructive process.

Delayed Reconstruction with a Breast Implant

Unlike immediate breast reconstruction, delayed breast reconstruction does not begin at the time of your mastectomy. Delayed breast reconstruction surgery may begin weeks, months, or even years after your mastectomy. Your plastic surgeon will begin reconstructive surgery at whatever time you and your care team decides is best given your unique situation. Two-stage reconstruction is the only procedural option if you elect to have delayed reconstruction surgery because the skin over your chest will have contracted and lost the breast shape in the intervening time.

Two-stage delayed breast implant reconstruction involves a combination of procedures to gradually expand the skin on your chest into the shape of a breast and create a pocket for the breast implant to occupy. Delayed breast reconstruction starts with the placement of a breast tissue expander. The breast tissue expander is gradually filled with sterile saline fluid to expand and grow your skin. Several months later the tissue expander is replaced with a breast implant, after enough new skin has been created to obtain the best result.

Potential Advantages of Delayed Breast Reconstruction Surgery

  • Some women find the breast cancer diagnosis to be overwhelming and would prefer to delay any decision-making that is not directly related to treating the cancer. Delayed reconstruction minimizes that added pressure by allowing patients to have more time to consider their reconstructive options.
  • Delayed reconstruction allows your team of physicians to expedite other cancer treatments - such as radiation therapy and chemotherapy - if healing difficulties with reconstruction are anticipated.

Potential Disadvantages of Delayed Breast Reconstruction Surgery

  • Because reconstruction is not begun when your mastectomy occurs, delayed reconstruction involves at least one more visit to the hospital.
  • Scarring from your mastectomy may make reconstruction more difficult.
  • Some women experience emotional distress related to the lack of a breast mound after a mastectomy.

It is important to understand that any breast reconstruction surgery (with or without breast implants) may require multiple procedures. Your surgeon may also recommend a procedure that provides better symmetry or balance between your breasts. These symmetry procedures for the unaffected breast can include breast augmentation with an implant, breast reduction (reduction mammoplasty), or a breast lift (mastopexy).

You may additionally desire to have nipple reconstruction. These minor, outpatient procedures help recreate your pre-mastectomy breast appearance. A variety of different techniques are used for these procedures. You should discuss your options with your plastic surgeon for best results.

The exact number of procedures and estimated recovery times will vary for every woman. Your general surgeon, plastic surgeon, and oncologist should work together as a team to plan your individual reconstructive process.


Breast reconstruction performed at the time of the mastectomy often requires a short overnight stay at the hospital, although you and your surgeon may choose to have the procedure done on an outpatient basis. Subsequent operatives are typically performed as outpatient procedures in a hospital operating room, surgery center, or surgical suite in a plastic surgeon’s office. However - depending on individual factors - you and your surgeon may choose an approach that requires an overnight stay at the hospital. General anesthesia is most common. You and your surgeon will discuss the best anesthesia for you.
Although every case is different, on average, the surgery lasts one to two hours.