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How implants can be used in reconstructive surgery following breast cancer

Posted Jan 20 2012 8:27am

Approximately one in five patients with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. will require a mastectomy rather than a lumpectomy. As mastectomy results in the distortion of the body image, it is natural for some patients to seek reconstructive surgery. However, some women are just relieved to have had the cancer removed and are not keen on having breast reconstruction. Although an external implant is available that can be put inside the brassiere, it may be inadequate for some women.

The choice of reconstruction depends upon the woman's build, shape and size of her breasts, previous scars, and her own preferences.

An implant is inserted under a muscleTissue made up of cells that can contract to bring about movement. in the chest wall at the mastectomy site. Implant reconstruction can be performed immediately at the time of skin-sparing mastectomy or as a delayed procedure through the original mastectomy scar. There has been a recent concern regarding the safety of silicone implants. In fact, there is no evidence that FDA-approved silicone implants (Allergan and Mentor brands) increase the incidenceThe number of new episodes of a condition arising in a certain group of people over a specified period of time. of breast cancer or other diseases, such as arthritisInflammation of one or more joints of the body.. The main problems with implants are infectionInvasion by organisms that may be harmful, for example bacteria or parasites. (occurring in 2% of patients) and scarring around the implant. Scarring makes the breast feel hard and painful which is more common if the prosthesisAn artificial device attached to the body. is very smooth.

An example of a tissue expander (saline filled)    An example of a tear-drop silicone implant

Modern implants consist of an outer silicone shell (roughened or textured) and an inner compartment that can be filled with saline (salt water) instead of silicone gel. Implants having a similar shape to the natural breast have recently been introduced. Your breast surgeon will explain the pros and cons of the various types of implant available to you and you should request to see pictures showing the outcome of the various methods.

All patients undergoing mastectomy should be offered the possibility of breast reconstruction, either performed immediately at the time of mastectomy, or as a later procedure. Mastectomy combined with immediate reconstruction is preferred and seems to cost less than mastectomy with subsequent delayed reconstruction. There is no evidence that immediate reconstruction at the time of mastectomy worsens the breast cancer outlook. Frail patients with other medical problems are not advised to undergo breast reconstruction surgery as they have a higher risk of complications.

There are various methods of reconstruction and the choice should be made after discussion with the breast surgeon, specialist breast nurse and other patients who have had breast reconstruction. I prefer the type of mastectomy that preserves most of the natural skin envelope of the breast (called a skin-sparing mastectomy) when performing immediate breast reconstruction in view of the superior cosmetic result.

Conventionally, the use of under the muscle implants has been restricted as expansion of the lower pole (infra-mammary fold) involves repeated sessions of gradual inflation of the implant to achieve a natural profile. The acellular Containing no cells. tissueA group of cells with a similar structure and a specialised function. matrix has been shown to incorporate well into human tissues, with no rejection. The most commonly used tissue matrix (Strattice®) is derived from porcine (pig's) skin and does not contain any cellular DNAThe building blocks of the genes in almost all living organisms - spelt out in full as deoxyribonucleic acid.. This matrix allows for one stage breast reconstruction using a fixed-volume silicone implant and has widened the scope of implant-based breast reconstruction. Incorporation of the mesh results in an intact acellular matrix of natural biological components that promote rapid re-vascularisationThe process of blood flowing through the area. and cell re-population around the implant thus improving the cosmetic result and feel of the implant.

The skin-sparing mastectomy method of reconstruction involves the removal of the latissimus dorsi flap from the back for use in the reconstruction. For further information please click here .

Other methods of reconstruction include breast implants, either saline-filled tissue expanders or silicone implants.

Surgery carried out by the author, Kefah Mokbel , in 2003 (viewable on the link below) shows the long-term cosmetic result of SSM plus latissimus dorsi flap reconstruction. A 52 year old lady had right skin-saving mastectomy and immediate breast reconstruction using a skin and muscle flap from the back for early breast cancer. She also had nipple reconstruction and enlargement of the opposite breast in order to achieve symmetry.

The following image link shows a left skin-saving mastectomy and immediate breast reconstruction using a skin and muscle flap from the back for early breast cancer in a 49 year old lady. She also had nipple reconstruction and tattooing.

The image found on the link below shows the long-term result of an immediate breast reconstruction in a 47 year old woman. She had a bilateralOn both sides of the body SSM using implants followed by radiotherapyThe treatment of disease using radiation. to the right breast and nipple reconstruction using small local flaps and tattooing.

Stages of nipple reconstruction using local flap

It is also possible to reconstruct the nipple using local skin, a portion form the opposite nipple, or a skin graft taken from the groin. The new nipple can be tattooed to make it a similar colour to that of the opposite nipple. A disposable tattooing instrument is used to minimise the risk of disease transmission.

The following image link shows the post-surgery result of a nipple reconstruction prior to tattooing.

From top right to bottom left this figure shows the steps of performing a nipple reconstruction using a small local flap.

In selected cases the nipple can be preserved during skin-sparing mastectomy and reconstruction in order to achieve a superior cosmetic result.

The photo found on the link below shows the excellent cosmetic result from bilateral nipple-saving mastectomy and implant reconstruction in a 40 year old diagnosed with breast cancer.


For further information please see the following article by Prof Kefah Mokbel and colleagues.

Reefy S, Patani N, Anderson A, Burgoyne G, Osman H, Mokbel K. 2010. Oncological outcome and patient satisfaction with skin-sparing mastectomy and immediate breast reconstruction: a prospective observational study. BMC Cancer 10:171.

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