For most patients, one of the first major decisions after deciding to proceed with reconstruction is deciding between breast reconstruction using their own tissues (various types of flaps) or using implants. There are advantages and disadvantages to each approach. In some cases it may be necessary to use implants with muscle or tissue flaps (see Flap Reconstruction With Implants).

For many patients, after the mastectomy there is not enough skin or tissue around the breast to allow for immediate placement of a breast implant. For those patients, the first stage of surgery is to insert a tissue expander. A tissue expander is very similar to an implant except that there is only a small amount of fluid inside it initially so it is quite flat.

After the patient's incisions heal from that first stage of surgery, the doctor begins the process of expansion. This involves the patient coming to the office every 1-2 weeks for expansion. At each office visit the doctor uses a needle to insert saline into the expander to increase its size. As the amount of saline increases in the expander and it increases in size, the skin covering the expander stretches also. Each of these visits typically takes 10-15 minutes and patients usually find the expansion to be relatively painless.

Eventually, the expander reaches the size the patient desires and now there is sufficient skin available. The second stage of surgery then takes place in which Dr. Duffy removes the expander and replaces it with a permanent implant.

What Types Of Implants Are There?

There are basically two types of implants available to choose from - saline and silicone. Silicone implants can only be placed by surgeons who participate in one of several adjunct studies. Dr. Duffy participates with the Mentor adjunct study and is therefore able to offer his patients the choice of either saline or silicone implants.

Saline implants are actually implants made of a solid silicone shell and filled with saline. Silicone implants are made of a solid silicone shell and are filled with silicone gel. Many patients have heard about "cohesive gel" implants. All the silicone gel implants utilized by Dr. Duffy from Mentor are cohesive gel implants. This simply means the gel filling the implants is of a very thick consistency and acts as a unit rather than a liquid. It holds together uniformly. The choice of which implant to use is made by the patient with Dr. Duffy's input. Dr. Duffy provides his patients with information regarding the safety of implants and the differences between the implants.

In addition to choosing silicone versus saline, there are also different shapes of implants. For the vast majority of patients, a round implant or high profile implant is most appropriate. Dr. Duffy works with each patient to recommend the best shape of implant to meet that patient's needs.

What Are The Advantages And Disadvantages of Implant Reconstruction?

Advantages:

• The recovery from the initial expander placement surgery is usually quicker than flap surgery.
• It may be easier to control the final size of the reconstructed breast with implant reconstruction.
• There are no additional scars on the patient's body other than those on the breasts.

• Because most patients require placement of an expander first followed by secondary replacement of the expander with an implant, this requires at least 2 surgical stages and multiple visits to the plastic surgeon's office between these stages for tissue expansion.
• It is important to realize that for patients who are having a unilateral (one-sided) mastectomy, matching the contralateral natural breast with an implant can be difficult. The shape and "feel" of an implant is not exactly like that of a natural breast.
• In the short term, implants can become infected or malpositioned and require surgery to correct these problems.
• In the longer term, implants can develop capsular contracture (tightening of the soft tissues around the implant), implant malposition, and implant rupture. All of these can require secondary procedures.