Tissue Expander/Implant

Breast reconstruction after mastectomy is becoming increasingly common as more women become educated about their options surrounding breast cancer treatment. Sound oncologic treatment of the cancer is, of course, the primary goal. But there is life after breast cancer, and multiple studies have proven an increase in quality of life after mastectomy if the patient undergoes breast reconstruction. Although there are several basic options for reconstructing a breast, the timing and choices surrounding reconstruction can quickly become complicated when considering the cancer treatment plan. Creating a unique plan that addresses both the cancer treatment and reconstruction is vital to a successful outcome. Dr. Gordley will help to guide you through this complex process as smoothly as possible.

The three basic options for breast reconstruction are elaborated upon below. Please know that not every patient is a good candidate for every procedure, and that your reconstruction will be tailor fit to your exact situation.

  • Tissue expander/Implant reconstruction- After mastectomy there is a shortage of both skin and volume. Perhaps the simplest method of reconstruction is to place a tissue expander (inflatable implant) underneath the skin, to then serially inflate the expander in the office, and then exchange this implant several months later for a more permanent implant. The upside of this method is the relatively easier recovery time, short predictable surgeries, and a very reasonable result. The downside is the potential for scar contracture around the implant (requiring surgical revision), at minimum 2 surgeries and multiple office visits. In addition, these breasts may not be as natural appearing as the other methods described below.
  • Autologous tissue (abdominal tissue reconstruction)- Just as above, there exists a paucity of both skin and volume which can be reconstructed using fat and skin from the abdomen. The typical incisions are the same as that of a tummy tuck, which is a side benefit of the procedure. There are several techniques used to transfer this tissue up to the chest, depending on the amount of tissue needed and potential effects on the abdominal muscles. Dr. Gordley is facile in “free” tissue transfers, and muscle sparing procedures (DIEP, SIEA and muscle sparing TRAM) will be used in select patients. The upside of this method is the natural appearing and natural feeling result, which requires no implant. An added benefit is the simultaneous tummy tuck. The downside is the longer recovery (6-8 weeks), the potential for abdominal hernia and muscle weakness, and a more complicated lengthy procedure.
  • Latissimus dorsi and implant reconstruction – A good mixture of the pros and cons of the above, the latissimus reconstruction is a reasonable option for some patients. By transferring a muscle from the back with overlying skin, the skin portion of the reconstruction is satisfied. Then, an implant is used to replace the missing volume. The back muscle is quite expendable and there is minimal functional impairment after the surgery. There is still the potential for implant-related issues and need for revisions in the future, but the recovery is 3-4 weeks and the aesthetic result is somewhere in between the other two options.

The final finishing touches of breast reconstruction are the nipple reconstruction (which is done in the office), and tattooing of the areola.