To rebuild the breast mound after a mastectomy, the choice is either implant reconstruction or tissue (flap) reconstruction. Which of these procedures you and your doctor pick depends on your body type, breast size, and preference.
Implant Reconstruction
Implant reconstruction can be done at the same time as a mastectomy (called direct to implant), but it may not be the ideal method. “The revision rate [having additional surgery later] of direct-to-implant is higher than if you do the procedure in two stages,” says Butler. That’s because the skin over the breast may get stressed or injured during a mastectomy. “If I then place a large implant into that skin pocket, I’m stressing the skin even more, which can lead to complications such as implant extrusion [when the implant pushes through the skin] or infection.”
Instead, the procedure is usually done in stages. First, the surgeon places a tissue expander under the skin at the time of the mastectomy. “Then we inflate the tissue expander, sort of like inflating a balloon, every few weeks in the office until we reach the right size. Once we reach the right size, then we bring the patient back for a small outpatient procedure where we remove the tissue expander and place the implant,” says Lyle Leipziger, MD, chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center in New York.
Flap Reconstruction
One advantage to flap reconstruction is that it uses your own tissue instead of a foreign implant. “A second, smaller surgery is typically needed to adjust the tissue and shape the breast,” Dr. Colwell says.
Nipple and Areola Reconstruction
With a mastectomy, in most cases, the surgeon is able to preserve the skin of the breast and only removes the tissue underneath. “It is often also possible to keep the nipple of the breast in a nipple-sparing mastectomy procedure,” says Colwell.
