Two-Stage Implant Breast Reconstruction
Two-Stage Implant Reconstruction involves two different surgeries:
- Tissue Expander Surgery
- Implant Reconstruction
Preparing for Two-Stage Implant Reconstruction Surgery
If you are a smoker, you should try to quit before surgery, as the risks of complications are higher in smokers. You should stop taking all over-the-counter pain or fever medicines (except Tylenol) and blood thinners for two weeks prior to your procedure. Many herbal medicines can also cause bleeding and so need to be stopped before surgery. Examples include ginkgo biloba, St. John’s Wort, and high doses of fish oil, flax seed oil, or vitamin E.
When is Two-Stage Implant Reconstruction Used?
Breast reconstruction with a tissue expander followed by an implant is done in women who are interested in implant reconstruction or who don’t have enough donor tissue elsewhere on their body to make a breast. It can be done as a unilateral (one breast) or bilateral (both breasts) breast reconstruction. It is also recommended for women who have a lot of other health problems that may preclude them from being a candidate for the longer surgery times required with autologous reconstruction.
Furthermore, two-stage breast reconstruction may be used for women who want immediate reconstruction at the time of the mastectomy. The appropriateness of this method depends on the extent of the cancer surgery required and the desired size of the new breast. If there isn’t enough skin to cover over the implant at the time of a mastectomy, a deflated tissue expander needs to be placed first. Two-stage implant reconstruction is also used in women who have already had a mastectomy and wish to undergo delayed implant reconstruction. These patients need the tissue expander to first stretch-out the skin prior to implant insertion.
Tissue Expander Surgery at a Glance
1-2 hours for mastectomy and to place implant or expander
Usually 1 night, occasionally can go home same day
Recovery room 3 hours
2-3 weeks for initial healing
2-3 months to expand pocket (done every 1-2 weeks)
6-12 months for final results
Implant Surgery at a Glance
About 1 hour to place the implant
Day surgery - occasionally one night stay
2-3 weeks to fully heal the incision
- It’s simple and predictable
- No donor site morbidity
- Shorter surgery time vs. autologous (flap) option
- Shorter recovery vs. autologous
- It can always be changed to autologous flap option at a future date if complications arise
- Implant location does not camouflage any local recurrences of the tumor
- Larger implants can be used compared to one stage direct-to-implant reconstruction
- Sensation of native skin flaps preserved
- Requires a minimum of two operations
- Lengthy process (numerous and frequent visits for expansion)
- Requires good quality skin
- Higher rates of complications in patients who have had radiation
- Increased risk of infection or implant exposure
- May make skin resistant to expansion
- Increased potential for capsular contracture (hard scar that forms around the implant because it is foreign)
- Increased risk for device failure or leakage (very low)
- Increased risk of need for future operations compared to autologous reconstruction
- Breast will not develop natural drop with advancing age compared to a natural breast (this is important for single-sided reconstructions)
Tissue Expander Surgery
The first stage, which can be done at the time of mastectomy (immediate) or at a later date (delayed), involves lacing a balloon-like tissue expander under the skin and muscle of the chest. Most patients stay overnight in the hospital after the procedure.
Once the expander has been inserted, your plastic surgeon will inject small amounts of saline to inflate the expander at weekly or bi-weekly clinic appointment over the course of a few months. When the tissue expander is fully inflated, the skin is allowed to settle for a few months before the second stage.
First-Stage Recovery Process
Patients will have drains in place after the surgery and your plastic surgeon usually removes these in the office within 1-2 weeks. You cannot shower as long as you have drains in place. It is common for patients to need to keep a bandage over the incision for comfort and to collect any small bits of drainage for the first 1-2 weeks, until the incisions have healed. Most sutures will be absorbable. Patients can wear a bra after surgery if comfortable but this is not necessary.
Some women find they can return to work within a couple of weeks, though most take an extended leave to help recover physically and mentally from the cancer therapy.
Implant Reconstruction Surgery
Breast implant reconstruction involves placing a saline or silicone implant beneath the skin and muscle layers of the chest. It is a day procedure with a much quicker recovery time than the tissue expander surgery. The second stage breast reconstruction is usually done 3-6 months after the first stage. Nipple reconstruction and tattooing are then done at a later date under local anesthetic.
Second-Stage Recovery Process
The chest often aches and is bruised for a couple of weeks. Women are given a prescription for antibiotics and painkillers. Patients should avoid vigorous activity or heavy lifting for a couple of weeks after surgery. The exact recovery can vary considerably and often depends on the patient’s health and fitness before surgery, the extent of the surgery and cancer, whether it was an immediate or delayed reconstruction, and the need for radiation and chemotherapy after surgery. Most patients are back to doing most activity by 6 weeks but it can take 6-12 months to fully recover after the surgery.