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Abstract
Since the early detection rate of breast cancer is increasing and skin- or nipple-sparing mastectomies have become popularized recently, the need for breast reconstruction using implants is continuously increasing. Simplicity of surgical techniques, short operation time, short hospital stay, short recovery time, no need for donor site defects and scars, and reconstruction with tissue of same color, texture, and sensation are the main advantages of implant reconstruction. However, reconstructed breasts using implants tend to be less natural and ptotic, sensitive to external temperature, unable to adapt to the normal aging process of the breast, and may have implant related complications. In patients with postoperative radiation, implant reconstruction is not indicated because of decreased skin flap circulation and increased implant related complications. Although autologous tissue reconstruction is known to produce natural and aesthetic breasts, similar results can be achieved by implant reconstruction when it is well indicated and performed with appropriate techniques by experienced surgeons. Implant reconstruction is best suited for young, active women with small round breasts and slender bodies.
Figures and Tables
Figure 1
Pocket design for expander/implant insertion. The inferomedial insertion of pectoralis major muscle is cut to relieve tension and unwanted muscle action around the implant (From Ahn ST. Aesthetic and reconstructive breast surgery. Seoul: Koonja Publishing Co.; 2010, with permission from Koonja Publishing Co.) [13].
Figure 2
Expander/implant insertion. (A) The lateral margin of the pectoralis major muscle is sutured to the serratus anterior muscle flap. The upper part of the implant is covered by the pectoralis major muscle and lower part is in the subcutaneous position. (B) Lateral view after implant insertion. The skin incision is located over the pectoralis major muscle (From Ahn ST. Aesthetic and reconstructive breast surgery. Seoul: Koonja Publishing Co.; 2010, with permission from Koonja Publishing Co.) [13].
Figure 3
Immediate breast reconstruction using an implant only in the patient with the nipple sparing mastectomy. (A) Preoperative view. (B) Postoperative view after reconstruction with a 250 mL implant.
Figure 4
Expander/implant insertion using AlloDerm. (A) AlloDerm is sutured between the inferior margin of the pectoralis major muscle and the inframammary fold to reinforce the subcutaneous pocket. The serratus anterior muscle flap is not elevated to fix the AlloDerm. (B) AlloDerm supplemented as an additional layer between the subcutaneous pocket and implant (From Ahn ST. Aesthetic and reconstructive breast surgery. Seoul: Koonja Publishing Co.; 2010, with permission from Koonja Publishing Co.) [13].
Figure 5
Siltex contour profile breast tissue expander (Mentor, Santa Barbara, CA, USA). Comparison of width and hight among low-, medium-, tall-height expanders (From Ahn ST. Aesthetic and reconstructive breast surgery. Seoul: Koonja Publishing Co.; 2010, with permission from Koonja Publishing Co.) [13].
Figure 6
Delayed breast reconstruction using a tissue expander and breast implant. (A,B) Preoperative view of the 40-year-old female with the modified radical mastectomy. (C,D) Her right breast was reconstructed by 550 mL expansion with a medium-height contour profile expander and a 421 mL mid-range profile smooth cohesive silicone gel implant. Her left breast was augmented by using a 260 mL cohesive silicone gel implant. (E,F) Postoperative view after C-V flap nipple reconstruction and tattoo.
References
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