In implant-based breast reconstruction, an implant is used to recreate the breast form in order to reproduce the desired shape and volume of the breast and to restore to the best degree possible reasonable symmetry of your breasts. Breast reconstruction using an implant can be completed in one of two ways: in a One-Stage Reconstruction (also known as a Direct-to-Implant Reconstruction), or a Two-Stage Reconstruction (known as a Tissue Expander-to-Implant Reconstruction).
In some cases, after a mastectomy, a surgeon may recommend inserting the implant (made of silicone or saline) directly without having to expand the breast pocket with an expander. This is called a Direct-to-Implant or One-Stage Reconstruction.
Alternatively, in Two-Stage Reconstruction or Tissue Expander-to-Implant, an expander, which works in a way similar to a balloon, is placed instead. Using a tiny valve beneath the skin, the surgeon can inject a salt-water solution into the expander at regular intervals to fill the expander over time. This can be a process of several weeks until the desired size or volume is achieved.
In the case of Two-Stage Reconstruction, after the skin and muscle over the breast has stretched enough to form a pocket to accept the implant, a second procedure (on average 4-6 months later) can be performed to remove the expander and place a long-term silicone or saline implant into the newly expanded space (also known as the breast pocket).
Breast reconstruction with implants account for approximately 70% of all breast reconstruction procedures. To review some of the potential advantages and disadvantages of choosing breast implants for reconstruction, please refer to the chart.
Potential Advantages | Potential Disadvantages
- No donor site complications (such as muscle weakness, pain, scarring, bleeding or infection)
- Shorter surgery
- Quicker recovery and hospital stay
- Does not involve movement of abdominal or back muscle
- Additional surgeries (such as implant removal and revisions)
- Higher complication rate – increased risk of capsular contracture and infection
- Postoperative breast pain
- Changes in nipple and breast sensation
- Possibility of implant rupture
- Possible differences in size and shape of breasts including implant migration
- Foreign implant in your body
- Breast implants are not permanent
Over the last fifty years, surgeons have continually evolved techniques to improve breast reconstruction, beginning with the Full Muscle Coverage and Partial Muscle Coverage techniques. In recent years, many surgeons have turned to biological tissue matrices because they may provide surgeons with a tool to optimize surgical outcomes. Plus, biological tissue matrices have many advantages over Full Muscle Coverage and Partial Muscle Coverage techniques. Review your options carefully and consult with your surgeon to understand what option is right for you.