Definition & Overview
Many patients who undergo breast surgery, such as mastopexy and mastectomy, are worried about the cosmetic results of such procedures. As such, some of them opt to immediately undergo breast reconstruction. This is usually performed by placing breast prosthesis in the cavity left by the procedure to restore the appearance of the breasts.
Who Should Undergo and Expected Results
The immediate insertion of breast prosthesis is an option for mastopexy and mastectomy patients. These breast surgeries are performed to treat:
- Breast cancer
- Severe fibrocystic breast disease or cystic mastitis
- Sagging breasts
The patient's surgeon may recommend the immediate insertion of prosthesis due to the following advantages:
- Immediate breast reconstruction following a medically necessary breast surgery is also considered as medically necessary. This means the patient is qualified for health insurance claims.
- The patient only has to undergo one procedure and therefore only has to recover once.
- The patient will have only one incision and a lower risk of scarring.
- The patient will have fewer visits to the doctor.
- The patient will undergo a shorter reconstruction process.
- There will be fewer challenges to the procedure. Women who undergo a mastectomy may have a scar that may make future procedures more challenging.
- The risk of emotional distress caused by breast loss is significantly reduced.
On the other hand, delayed breast reconstruction can be performed weeks, months, or even years after a mastopexy or mastectomy. It is usually performed when the patient is done with her cancer treatment.
The main disadvantage of a delayed reconstruction is that it has to be performed in two stages. This is because the skin over the patient’s chest will already have changed shape since the mastectomy or mastopexy was performed. Thus, the skin will first need to be expanded before the breast prosthesis can be placed. The first stage will focus on gradually expanding the chest skin to accommodate a pocket, called a tissue expander, for the breast implant. It may need to stay in place for several months before the breast implant can finally be placed. This means that the patient has to undergo a long and extended process to restore her breast shape to normal.
Despite these disadvantages, some women choose to delay their breast reconstruction procedure. In breast cancer cases, some find it overwhelming to make so many decisions regarding reconstruction while they are still dealing with their cancer diagnosis. Delayed reconstruction gives patients more time to consider their options, which can minimise the risk of regretting their decision in the future. In some cases, the insertion of breast prosthesis may also get in the way of future cancer treatments such as chemotherapy or radiation therapy.
Thus, not all women have the option to have breast prosthesis right after their breast surgery. In general, only those with stage I and II cancers that are less likely to require radiation or chemotherapy can choose immediate placement. In contrast, women with late-stage cancers usually do not have the same option.
When seeking immediate insertion of breast prosthesis following a mastopexy or mastectomy, patients can choose among several different types of breast prosthetics to achieve their goals. Most prosthetics are made of silicone gel, but they have different amounts and layers of silicone. They also come in various cup sizes and shapes. There are also non-silicone ones.
How is the Procedure Performed?
The following steps are taken to immediately insert breast prosthesis into the breast cavity following a mastopexy or mastectomy:
- Prior to mastectomy or mastopexy, the patient undergoes a fitting procedure to select the best type of prosthesis for her.
- The patient is then placed under general anaesthesia.
- A mastopexy or mastectomy is performed. A mastopexy is a cosmetic procedure that aims to raise sagging breasts. A mastectomy, on the other hand, refers to the partial or complete removal of breast tissue to treat breast cancer.
- Once mastopexy or mastectomy has been completed, the plastic surgery team will take over from the breast cancer surgery team.
- The plastic surgery team inserts the breast prosthesis into place. The prosthesis can be placed against the skin or attached to the chest wall.
- The incision is closed with stitches.
- A temporary tube may be attached to the wound to drain out excess fluid.
Possible Risks and Complications
Patients who undergo immediate insertion of breast prosthesis following a mastopexy or mastectomy face all the common risks of breast surgery including:
- Incision lines or scars
- Breast asymmetry
- Numbness or loss of sensation
Allergic reaction to anaesthesia
Roostaeian J, Sanchez I, Vardanian A, Herrera F, Galanis C, Da Lio A, Festekjian J, Crisera CA. “Comparison of immediate implant placement versus the staged tissue expander technique in breast reconstruction.” Plast Reconstr Surg. 2012 Jun; 129(6). http://www.ncbi.nlm.nih.gov/pubmed/22634689
Shankar RA, Nibhanupudy JR, Sridhar R, Ashton C, Goldson AL. “Immediate breast reconstruction-impact on radiation management.” J Natl Med Assoc. 2003 Apr; 95(4): 286-295. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594603/