Today, the innovative one-stage breast reconstruction technique is growing in popularity. The one-stage breast reconstruction procedure will be performed at the same time as the mastectomy; avoiding the tissue expander process and follow-up surgical procedure to place permanent breast implants. A single stage process is an exciting option for the woman undergoing a nipple-sparing mastectomy; the results are natural looking and immediate. The technique can be tailored to meet an individual woman’s body type and aesthetic goals.
Direct-to-implant, or one-stage, breast reconstruction may have several benefits, but it is not everyone. The best candidate for the procedure will be a woman who is happy with her current (or smaller) breast size. She should also have healthy, taut breast skin that is able to accommodate the implant or newly created breast mound.
After a mastectomy, there is often not an adequate amount of skin and muscle remaining to accommodate a breast implant, in which circumstance, the placement of a tissue expander is appropriate. Additionally, a dermal matrix, such as Flex HD or Autoderm, may be utilized which will then form a latticework around the implant, and, over time, incorporate into your natural tissue. A tissue expander works like an inflatable implant, placed below the pectoralis muscle, and slowly filled over a period of time in the office. This will stretch the overlying muscle and skin so a pocket can be created in which to place the permanent breast implant.
When the tissue expander is placed, and how long it stays in, will depend on several factors. These include the patient’s unique anatomy, as well as the need for chemotherapy, radiation, or other post-mastectomy treatments.
Once the tissue expander is placed, it will be slowly filled with saline. Approximately every one to two weeks, additional saline will be injected through a small port on the expander. Each session will take about 20 minutes to complete. Shortly after the tissue expansion session, light activities can be resumed.
Immediately after the solution is added to the expander, you may feel pressure or a slight burning sensation in the chest. This is common, as the muscles and skin are stretched. While filling the tissue expander may be uncomfortable, most women do not find the process to be painful; the sensation typically lasts only a day or so.
Once the breast tissue has reached the desired size, a second surgical procedure to remove the expander will be performed. At this time, a permanent saline or silicone breast implant can be placed. This is referred to as an implant exchange and is generally scheduled four to eight weeks after the final tissue expansion.