Direct to Implant Reconstruction
Congratulations for making this far and seeking to understand your reconstructive procedure better. Immediate prosthetic breast reconstruction utilizes prosthetic silicone implants to reconstruct your breast.
Immediate prosthetic reconstruction is mostly offered to patients as a risk reducing procedure or patients with early stage tumour that will not require radiation. Radiation therapy adversely affects a prosthetic reconstruction.
All patients receiving immediate prosthetic reconstruction will have a sentinel lymph node biopsy before the mastectomy and reconstruction. The sentinel lymph node biopsy will stage the disease process and anticipate additional treatments needed, for example radiation or chemotherapy.
The breast cancer surgeon performs the skin sparing mastectomy. A skin sparing mastectomy is a procedure where most of the breast tissue is removed maintaining the skin of the breast which will serve as an envelope for the reconstruction. 98% of breast tissue is removed via the skin sparing mastectomy. It is important to note that it is impossible to remove all the breast tissue as some breast tissue will still be attached to the breast flaps. This emphasizes the importance of radiological screening even if you have had a skin sparing mastectomy. You would still have to go for a breast ultrasound once a year.
The nipple areola complex has a major aesthetic implication, not only the presence or absence thereof, but also the symmetry between the two breasts. The oncological surgeon will removed the nipple areola complex depending on tumour factors if so indicated and/or patient requests. All nipples that are left behind will have intra-operative histology to make sure there is no disease in the nipple. All normal breasts will also have an axillary lymph node sampling to exclude any underlying tumour.
In our unit we perform the skin sparing mastectomy via different incisions. The type of incision depends on the size of the breast, the grade of ptosis (drooping) of the breast, previous operations and patient requests. The incision may be a lasy-S incision, an inverted T or anchor incision, infra-mammary fold incision, infra or peri-areolar or along previous incisions.
The decision process during direct to implant reconstruction.
The Size of the Implant
Prior to surgery it is important to give your reconstructive surgeon an idea of the breast size you prefer. Although an exact size can never be guaranteed we may be able to work together to give you an acceptable breast size.
The size of the implant depends on various factors. The pre-operative breast size, the size of the opposite breast and the intra-operative oncological findings. Generally it is better to choose an implant slightly smaller, larger or the same size as your current breast size. A radical change in size and shape is associated with a poor cosmetic result and increased complication rate.