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Breast Tissue Expander – Implant Reconstruction (2-stage)

Conveniently located to serve St. Louis, Missouri

An implant based reconstruction is the most common form of breast reconstruction done in the United States. This holds true in the St. Louis area as well. In this procedure, a temporary implant called a tissue expander is inserted in the breast after a mastectomy is done. The expander 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 inflate the tissue expander to a larger volume than otherwise possible at the time of mastectomy.

In addition, the incidence of capsular contracture, or irregular scarring around the implant, is reduced. This means there will be fewer fillings in the office and less time to final result. Finally, the use of mesh allows Dr. Cabbabe more accurate shaping and definition of a new lower breast fold with ideal breast shape. In select patients, a full size implant can be placed with this product at the time of surgery (one-stage implant reconstruction).

Candidates

If you are having or have had a mastectomy, you may be a candidate for this procedure. 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.

Surgery

This procedure may be done at the time of mastectomy or at a later time. If it is done at the time of mastectomy, Dr. Cabbabe will follow the breast surgeon into the operating room and insert the tissue expander into the breast. A biologic, regenerative mesh may be used to enhance the result. A drain will be placed in the breast for up to two weeks after surgery. If you have already had a mastectomy, the same steps are done.

Dr. Cabbabe will begin to inflate the tissue expander in the office, as early as one week after surgery. The needle will not hurt because the skin of the breast will be numb from surgery. He will inflate the expander at regular office visits until the desired size is achieved and sometimes slightly larger for the second stage surgery, depending on the type of implant to be used.

After the desired size has been reached, a second stage surgery will be done. During this procedure, the temporary tissue expander is removed, the capsule, or scar tissue around the breast, is manipulated and released in order to provide optimal shape and size. A permanent saline or silicone (round or shaped) implant is then placed. This is often done as an outpatient procedure. Fat grafting to the breast/chest is often incorporated as needed 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.

Recovery

Patients usually stay one night in the hospital then are discharge the following day. Dr. Cabbabe sees patients regularly/weekly after surgery.

Drains are usually only used at the time of mastectomy or tissue expander insertion. Recovery from the first stage can be from 3-4 weeks while recovery after the second stage is approximately 1 week. Antibiotics and pain medication is prescribed and patients are counseled as to what to watch for.

Types of Reconstruction: