One-Stage Implant Breast Reconstruction
One-stage breast reconstruction with implants can only be performed on an immediate basis. A permanent implant (saline or silicone) is placed under the pectoralis muscle. A sheet of acellular dermis is used to cover the bottom half of the implant. Acellular dermis is processed so that there is no 'rejection' by the patient. In addition, the chance of transfer of a communicable disease from such a product is very low. Use of acellular dermis eliminates the need for the tissue expander. AlloDerm®Tissue Matrix. Alloderm Breast Technique Video.
1. Overview
The typical candidate for implant surgery is 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.
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Patients that are not candidates for this type of surgery include:
Patients that smoke
Patients that are professional athletes
Patients with very large breasts
Patients with a BMI > 32. Click here to calculate your BMI.
2. Preoperative Considerations
3. Surgical Considerations
One-sided surgery:
This 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.
Two-sided surgery:
This surgery takes 3.5 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.
4. Postoperative Considerations
Following surgery patients are restricted from exercise or heavy activity for a period of 4 weeks. An underwire bra is worn 24 hours per day for the first 3 months. Nipple reconstruction is performed 3 months following surgery. Patients typically return to work after 2-3 weeks.
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5. 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%)
6. 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. Two studies available here provide a summary of the literature.
