Breast Implant Reconstruction St. Louis
An implant based reconstruction is the most common form of breast reconstruction done in the United States. This holds true in the Saint Louis area as well. In this procedure, an implant is inserted in the breast after a mastectomy is done. The implant may be placed under or above the chest muscle depending on the circumstances involved. This may be done at the time of mastectomy or at a later date depending on various factors. Mesh, or acellular dermis, is often incorporated in the procedure for optimal results.
Acellular dermis is skin which has been taken from a cadaver and processed to remove all of the cells of that person. The outer layer of skin is removed and the inner layer is utilized. This product is not experimental and has been used by experienced breast reconstructive plastic surgeons for years. The advantage of this product is that it allows Dr. Cabbabe to place a larger implant in a precise pocket than otherwise possible at the time of mastectomy.
In addition, the incidence of capsular contracture, or irregular scarring around the implant, is reduced. Finally, the use of mesh allows Dr. Cabbabe more accurate shaping and definition of a new lower breast fold with ideal breast shape.
A round or shaped silicone implant is generally recommended as these are the highest quality implants available in the United States. The choice is a personal one for the patient but Dr. Cabbabe uses his vast experience to guide patients to the right choice based on their desires and anatomy. Dr. Cabbabe only uses FDA-approved implants on his patients.
If you are having a mastectomy, you may be a candidate for this procedure. If you have had a mastectomy already, you will likely need a two – stage reconstruction with tissue expander first followed by implant placement at a later date.
Patients need to be healthy enough to undergo the procedure. Women who have small to medium breasts that do not have a significant degree of droopiness are excellent candidates. Otherwise, it can be difficult to obtain symmetry with the other breast, even with a breast lift or breast reduction.In these instances, Dr. Cabbabe may advise you to consider bilateral mastectomy.
Poor candidates for this surgery are women who have had prior radiation and mastectomy. The skin is very difficult to stretch in this condition and leads to an increased risk of skin breakdown and implant exposure, necessitating removal. Patients with previous radiation may require a more aggressive type of reconstruction involving tissue removal from other sites of the body such as the back (latissimus flap) or abdomen (TRAM, DIEP flap).
Preparing for Surgery
Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner. If you are taking chemotherapy, this needs to be finished prior to surgery.
This procedure is done at the time of mastectomy. Dr. Cabbabe will follow the breast surgeon into the operating room and insert the implant into the breast. A biologic, regenerative mesh is used to enhance the result as described. A drain will be placed in the breast for up to two weeks after surgery.
Fat grafting to the breast/chest may be recommended to enhance the final result. A breast lift or breast reduction may be needed on the other breast in order to improve symmetry if only one breast is removed. A new nipple can be made and areolar tattooing can be done if the nipple was removed.
Patients usually stay one night in the hospital then are discharged the following day. Dr. Cabbabe sees patients regularly after surgery.
Drains are used for up to 2 weeks after surgery. Recovery ranges from 3-4 weeks. Antibiotics and pain medication is prescribed and patients are counseled as to what to watch for.
Types of Reconstruction:
- Fat Grafting
- Oncoplastic Breast Reconstruction (one – stage)
- Tissue Expander – Implant (two – stage)
- Tissue Expander – Implant with Acellular Dermis (two –stage)
- Implant with Acellular Dermis (one-stage)
- Latissimus Flap (one – stage)
- Latissimus Flap with Expander – Implant (two – stage)
- Latissimus Flap with Implant (one-stage)
- Conventional TRAM (one – stage)
- Free Muscle – Sparing TRAM (one –stage)
- DIEP Flap (one – stage)
- SIEA Flap (one – stage)
- SGAP/LGAP (one – stage)
- Fat Transfer Breast Augmentation
- Breast Implant Reconstruction (One-stage)
- Breast Implant Revision Surgery
- Breast Tissue Expander – Implant Reconstruction (2-stage)
- Latissimus Flap Breast Reconstruction
- Latissimus Flap Breast Reconstruction with Implant (1-stage)
- Latissimus Flap with Implant Breast Reconstruction (2-stage)
- Transverse Upper Gracilis (TUG) Flap Breast Reconstruction