Implant Reconstruction

In this type of reconstruction a breast implant is placed in a pocket created on the chest wall. Implant reconstruction usually requires tissue expansion. In this process, a tissue expander is filled with saline over several weeks. The patient's body responds by stretching and creating new skin and muscle tissue. Once the desired size of the pocket is created, the tissue expander is removed and an implant is inserted. The implants used are filled with either saline or silicone gel. Another option that can avoid the use of tissue expansion is to cover an implant with muscle.

The latissimus dorsi is a large fan-shaped muscle of the back that can be rotated to the chest. In this procedure skin can also be taken if needed. More recently, foreign materials such as Alloderm (human cadaver allograft) have been used to create a sling to cover the lower portion of the tissue expander pocket. This can shorten the time needed for expansion, and in some cases, can allow for single-stage breast reconstruction, without the use of the latissimus dorsi muscle. Whenever an implant of any kind is placed in the body, a layer of scar tissue forms around the implant. This “capsule” varies in thickness, and can sometimes calcify and become hard. This is referred to as “capsular contracture”. The occurrence of capsular contracture is a concern with implant reconstruction. As a result of capsular contracture, implant reconstructions become more firm and can remain somewhat immobile, especially compared to a normal breast. If a patient has had radiation or is planning to have radiation, implant reconstruction is usually discouraged because of high rates of capsular contracture and other complications.

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