How does immediate breast reconstruction surgery work?
Immediate breast reconstruction surgery begins at the time of your mastectomy. After your general breast surgeon removes your breast tissue, your plastic surgeon will begin reconstructive surgery.
There are two procedural possibilities if you elect to have immediate reconstruction with an implant: one-stage and two-stage breast reconstruction.
One-Stage Immediate Breast Reconstruction with a Breast Implant
One-stage immediate breast reconstruction is a procedure in which your plastic surgeon places a breast implant immediately after your general surgeon removes any diseased 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 Immediate Breast Reconstruction with a Breast Implant
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 that uses a tissue expander followed by placement of a breast 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 natural breast shape. The tissue expander will be expanded periodically for approximately two to six months.
Immediate Breast Reconstruction with a Dual Function Implant
One additional option your plastic surgeon may suggest is placing a dual-function implant – a combination tissue expander and breast implant.This dual-function implant is ﬁlled with little to no saline in initially. Fluid is then gradually added by a procedure in doctor's office after your surgery—similar to 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.
Is one-stage breast reconstruction or two-stage breast reconstruction right for me?
Often, the amount of skin remaining in the breast area after a mastectomy determines whether reconstruction with an implant can be performed in one or two stages. For example, a complete mastectomy removes the most skin and will most likely necessitate the use of two-stage reconstruction. Your surgeon will discuss which type of implant reconstruction is best for you.