Plastic and Reconstructive Surgery

Breast Reconstruction with Implants

The following information regarding breast reconstruction utilizing breast implants is important for you to review, understand and discuss with family or friends before choosing to proceed with this surgery.

GOALS OF IMPLANT RECONSTRUCTION
The purpose of breast reconstruction with an implant is to restore the shape and volume of the breast which has been altered by mastectomy. With this technique, balance and symmetry can be restored and it is possible to look more normal in and out of clothing. In any given patient, these goals may be only partially met.

LIMITATIONS OF THE PROCEDURE
This procedure cannot replace the breast tissue exactly. Specifically, the reconstructed breast will never look or feel exactly the same as the normal breast. Sensation in the breast skin, as well as the reconstructed nipple areolar complex will not approach that of the unoperated breast. Multiple procedures are frequently necessary to achieve the best degree of symmetry, size or shape possible.

ALTERNATIVES TO THE PROCEDURE
Breast reconstruction following mastectomy is a personal choice and does not influence the outcome of the cancer surgery. Alternatives to implant surgery include staged implant reconstruction utilizing an inflatable saline expander which will stretch the skin in a first stage and allow larger or different shaped implants to be placed at a later date. This is desirable in patients in whom there is not enough skin or muscle to cover the appropriate sized implant or in patients who wish a larger breast size following mastectomy reconstruction.

Tissue flaps can be utilized from the back or lower abdomen to avoid the use of implants altogether. However, transfer of tissue flaps is a much more complicated surgical procedure and does carry higher risks of complications. In addition, there may be color differences in the skin between the skin from the flap and the reconstructed breast area. Finally, there are donor site scars and potential complications in the area from which the tissue flap is taken. Nipple/areolar reconstruction is performed as a separate procedure and usually as the last procedure in a staged breast reconstruction. Occasionally, to achieve the best cosmetic result, the normal unoperated breast will require surgical alterations such as breast lift, breast reduction or breast augmentation to help match the reconstructed breast.

BREAST CANCER IN THE OPPOSITE BREAST
After treatment of breast cancer in one breast there remains a risk for the development of breast cancer in the opposite breast. This requires life-long follow up including physical examination and mammographic screening. Surgery on the remaining breast to achieve symmetry with the operated breast should not interfere with cancer surveillance in the future. Breast reconstruction should not prevent examining the mastectomy site for recurrence, as cancer recurrence usually occurs in the scar on the chest wall or in the armpit area.

SURGICAL TECHNIQUES / ANESTHESIA / RECOVERY
Implant reconstruction can be performed either at the time of the mastectomy or in a delayed fashion. In either event the implant is placed underneath the chest wall muscles, as well as the muscles of the upper abdomen. Drains are placed around the implant and occasionally underneath the skin flaps and brought out through small incisions underneath the arm. These drains remain until the drainage decreases to less than 1 ounce per 24 hours. Frequently, steri-strips are applied over the incision which usually runs in a transverse fashion across the mid section of the breast towards the armpit. There may be shoulder stiffness following the mastectomy and physical therapy may be required at home or in a more formal setting to restore shoulder motion. Occasionally, swelling is note din the arm and fingers on the side of the mastectomy. If x-ray therapy is utilized following surgery for breast cancer, the incidence of arm swelling may be increased. Normal activities requiring upper body motion are usually restricted for 3-6 weeks following surgery. Following that time physical exercise is resumed to a normal level as tolerated. The procedure is usually performed under general anesthesia. Blood transfusions are usually not required. However, if you desire, your own blood or donor designated blood can be collected prior to surgery.

RISKS AND COMPLICATIONS
The most common complication following this surgery is a collection of blood or tissue fluid around the implant. If this causes swelling or tension on the skin closure it may be necessary for a second operative procedure to remove the collected fluid. Infection is extremely rare and usually responds to antibiotic therapy. However, in rare instances the implant must be removed before the infection can be cleared. The implant cannot be replaced for a minimum of 3-6 months following such an event.

As noted above, there will be pain and stiffness in the shoulder are and occasionally arm swelling. This usually responds to physical therapy. There can be delayed or incomplete wound healing which may require special dressings, secondary surgical procedures or removal of the implant if the implant becomes exposed through the skin incisions. There can be problems related to the implant itself, namely firmness of the reconstructed breast due to scar tissue formation around the implant. It is normal for the body to produce scar tissue around foreign material such as an implant. However, in some patients the scar tissue becomes so dense that the implant becomes immobile, hard and occasionally painful. In such instances surgery may be required to exchange the implant and cut the scar tissue. There may be implant failure due to spontaneous leakage of saline from the implant. The saline itself is of no harm to the body, but should the implant leak, it would require a second procedure to replace the implant. There may be wrinkling or irregularity of the implant surface which is noticeable either visually or when the breast is palpated. Additional operations may be required to change the implant size, shape or position.

Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon. Any and all of the risks and complications can result in:

• Additional surgery
• Hospitalization
• Time off work
• Expense to you

On occasion, surgical revisions may be indicated following the original surgery. If planned or performed within one year after the original surgery and if insurance does not cover these revisions, there will be no charge by the surgeon, but a facility fee will be charged by the hospital for use of the operating room, as well as a fee from the anesthesiologist. NO GUARANTEE -- The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee nor warranty expressed or implied by anyone as to the results that may be obtained.

COMMENTS
If a smoker -- must be off cigarettes for 3 weeks before surgery and 3 weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers. Must be off all aspirin containing products for 3 weeks before and after surgery. (Check all medications with us. Some medications, such as Motrin and Advil may also affect clotting.)

If there is any item on this consultation sheet that you do not understand, mark it and call the office. An explanation or additional information will be provided. Share the information that we provide to you with interested family members and/or friends. Our aesthetic coordinator, Connie Chudoff is available for any questions at 856-325-6768.