Stages

In the first stage an expandable, balloon-like tissue expander if placed under the patient’s chest wall muscle (pectoralis major) and skin. Beginning 2 to 3 weeks after surgery, the expander is inflated with saline (salt water similar to intravenous fluid) by inserting with a fine needle through the skin into the expander’s filling port. Inflation of the expander gradually stretches the skin of the chest wall and former breast area in a manner similar to weight gain or pregnancy in the abdomen. Expansion may take several weeks to months.

In the second stage the expander is removed and replaced with a “permanent” implant. The implant is made of a silicone bag and is filled with saline.

A third or more operations may be required subsequently to reconstruct the nipple areolar complex, improve the aesthetic result, or treat problems associated with implants.

Silicone

All issues and concerns regarding silicone should be discussed and agreed on before deciding on this technique. The medical literature has not proved an increase in connective tissue or autoimmune disease or systemic illness in women with silicone gel implants.Their incidence is no higher in women with implants than in women without implants in large studies. However, many women believe that their implants caused a connective tissue, autoimmune illness or chronic fatigue and musculoskeletal pain.

The effect of a silicone bag alone is not known. No increased incidence of illness has been found in women with silicone envelope/saline filled implants, but we can make no absolute claims of safety with the silicone bag.

Implant reconstruction should be considered an internal prosthesis. Implant reconstruction produces a less natural appearance and feel than reconstruction with one’s own tissue. Many women are happy with implant reconstruction. However implant reconstruction has a higher complication rate over the long term and a less satisfactory aesthetic result than the other techniques.

Pros of implant surgery:

• Shorter procedures (1.5 to 2 hours each)
• Requires same day surgery or one night in hospital
• Shorter recuperation time per procedure (approximately 3 weeks per procedure)
• Most patients are satisfied with the result (62% at 3 years)
• Often do not have to wear a bra

Cons of implant surgery:

• Usually not possible to match a normal breast shape and position
• Implant reconstruction’s shape is not a good as other methods (rounded, flatter shape with too much superior fullness, poor inframammary fold, droop not normal, size match difficult, shape match very difficult to impossible, the implant lies below the pectoralis muscle and may create distortion of the implant with exercise thinning of the muscle by the pressure of the implant allowing the implant to be easily felt below the skin, and the implant may frequently be felt beneath the skin and muscle as a slightly rippled bag)

Earlier than 2 months after surgery

Implant complication	Rate
Hematoma	1.9%
Skin flap necrosis	3.1%
Seroma	2.2%
Infection	1.9%

Later than 2 months after surgery

Implant complication	Rate
Capsular contracture	15%
Skin necrosis	2.5%
Implant deflation	7%