Immediate Breast Reconstruction

Immediate reconstruction is an option for many women and may be particularly
suitable if:

  • you are having preventative (prophylactic) surgery
  • you don’t have any complicating health issues
  • you are certain of your reconstructive choices.

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.

Potential Advantages of Immediate
Breast Reconstruction

  • When you wake up from surgery, you will either have a breast mound or be in the initial stages of creating a breast mound.
  • You may find it easier to cope with the mastectomy knowing that you will wake up with either a completely reconstructed breast or well into the process of restoring your breast.
  • You may save money, stay fewer days in the hospital and spend 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 are combined with reconstruction. These complications could include, but are 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 than with the timing of your reconstruction. Your surgeon can assess whether or not you are at a higher risk for these complications.

Additional Breast Reconstruction Procedures

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 or a breast lift.

You may additionally desire to have nipple reconstruction. These minor,outpatient procedures help recreate your pre-mastectomy breast appearance.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.