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Two-stage Implant Breast Reconstruction

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Overview

Two-stage breast reconstruction with implants involves a first surgery when the surgeon places a temporary implant under the pectoralis muscle called a tissue expander.
The general surgeon removes the breast gland and nipple through an elliptical incision. Once this is completed the pectoralis major and minor muscles are visible on the chest wall.

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The tissue expander is placed underneath the pectoralis major muscle. This implant has a port inside of it that is used to inject saline to inflate the tissue expander like a balloon. This is performed in Dr Macadam's office over approximately 4-6 weeks. Once the tissue expander is inflated to the desired size patients need to wait 3 months or 6 months (if they require radiation therapy) before the second surgery is performed.

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In the second surgery the tissue expander is removed and modifications are made to the breast shape. A permanent implant (saline or silicone) is then placed into the pocket that the tissue expander was removed from.

The only tissue covering the implant is the patient's pectoralis muscle, subcutaneous fat and skin.

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Preoperative Considerations

The typical candidate for implant surgery a woman who would prefer this surgery over using her own tissue, or a woman with insufficient tissue on the abdomen, buttock or inner thigh.

Patients that are not candidates for this type of surgery include:
Patients that smoke
Patients with a BMI > 32. Click here to calculate your BMI.

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Surgical Considerations

Immediate one-sided surgery:
The first surgery takes 2 hours. A drain is required in the breast and this is usually removed on post-operative day 10. The patient is required to stay in hospital one night. Patients typically return to work after 2-3 weeks. The second surgery takes 1-2 hours. No drains are required after the second surgery and the patient is able to return home on the day of surgery. Patients typically return to work after 10 days.

Immediate two-sided surgery:
This surgery takes 3 hours. Drains are required in the breasts and these are usually removed on post-operative day 10. The patient is required to stay in hospital one night. Patients typically return to work after 2-3 weeks. The second surgery takes 1.5-2 hours. No drains are required and the patient is able to return home on the day of surgery. Patients typically return to work after 10 days.

Delayed one-sided surgery:
The first surgery takes 1 hour. A drain is required in the breast and this is usually removed on post-operative day 10. The patient is able to return home on the day of surgery. Patients typically return to work after 10 days. The second surgery takes 1-2 hours. No drains are required and the patient is able to return home on the day of surgery. Patients typically return to work after 10 days.

Delayed two-sided surgery:
This surgery takes 1.5 hours. Drains are required in the breasts and these are usually removed on post-operative day 10. The patient is able to return home on the day of surgery. Patients typically return to work after 10 days. The second surgery takes 1.5-2 hours. No drains are required and the patient is able to return home on the day of surgery. Patients typically return to work after 10 days.

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Postoperative Considerations

Following surgery patients are restricted from exercise or heavy activity for a period of 4 weeks. After the second surgery an underwire bra is worn 24 hours per day for the first 3 months. Nipple reconstruction is performed 3 months following the second surgery.

Download Postop Brochure - Second Stage Surgery
Download Postop Brochure - Tissue Expander Insertion

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Possible Complications

Capsular contracture (felt to be lower than 20-30%, studies pending)
Mastectomy flap necrosis (15%)
Seroma (15%)
Wound healing complications (10%)
Implant malposition requiring additional surgery (Felt to be lower than 10%, studies pending)
Hematoma (5%)
Infection (1-2%)
DVT (0.07%-3.5%)
PE (0.09%-2%)

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Safety of silicone

Many patients undergoing breast surgery with implants have questions about the safety of silicone. This has been studied since the 1980s after concerns were raised about the possibility of silicone causing systemic disease. Epidemiologic evidence does not support an association between silicone and cancer, connective tissue disease, or neurologic disease. 2 studies available here provide a summary of the literature.