cancer treatment - breast reconstruction - implant
expander reconstruction - implantBreast reconstruction is a very personal issue and some couples would choose to have breast reconstruction following mastectomy and others would choose not to. There are various options including tissue transfer with the use of flaps, with or without implants and the use of prosthesis alone called an expander reconstruction. Your surgeon will be able to assess your body and determine the best form of reconstruction for you and discuss the pros and cons of all options with you. Expander reconstruction essentially involves removing all the breast tissue with or without lymph nodes as indicated by the breast cancer and therefore reconstructing the defect by placing an expandable implant under the pectoral muscle on the chest wall. 4/5ths of the surface of the prosthesis is covered by the muscle and the skin is closed over this with the nipple having been removed. The prosthesis has a port attached to it which is placed under the skin below the breast where it can be felt through the skin and injected with Saline in the rooms on a weekly basis. This allows for slow expansion of the muscle and the overlying skin and the implant can be over-inflated and thereafter deflated to create a small amount of natural droop. We use the Bekker 35 expander prosthesis which has a fixed volume of silicone present anteriorly and a pocket posteriorly which can be inflated with Saline. Expanders can either have a round or tear-drop shape and this is chose to match your body. Following full expansion of the prosthesis the port is removed under local anesthetic with sedation involving a small incision under the breast. The advantages of expander reconstruction are that no surgery is required in any other part of the body to harvest a flap to bring in the breast. This means a quicker recovery with less morbidity. The disadvantage is that the reconstructed breast does not feel as natural as the breast reconstructed with either the TRAM flaps or the latissimus dorsi flaps. The expander breast is firm and cool to the touch and has less natural movement in it. It does however provide good cleavage and a pert breast which sometimes necessitates a lift of the other breast to match this side. The risks of the operation are those of infection, bleeding, scarring, visibility of the prosthesis, palpability, rippling, capsular contracture and with extreme force – rupture. There is also a small risk of necrosis of the overlying skin with expansion, especially if pre-operative radiotherapy has been given.  Above: Breast reconstruction using tissue expansion and silicon implants Below: Submuscular postioning    |