How an implant reconstruction is done

An implant reconstruction can be done in one operation or as a two-stage operation.

Learn more about:

• One-stage operation
• Two-stage operation
• Acellular dermal matrix and synthetic mesh

One-stage operation

This operation is sometimes called a direct-to-implant reconstruction. It is done when there is enough tissue left on the chest to cover the implant. The surgeon inserts the implant either beneath the chest (pectoralis) muscle or in front of this muscle. The operation is usually done at the same time as a skin- or nipple-sparing mastectomy.

Placement of a breast implant

During a breast implant reconstruction the surgeon can place the implant above or below the chest (pectoralis) muscle.

	Subpectoral implant reconstruction Breast implant placed beneath the chest (pectoralis) muscle. This is called a subpectoral implant reconstruction. The lower and outer part of the implant is often covered by a dermal matrix or mesh to hold the implant in place.
	Prepectoral implant reconstruction Breast implant placed in front of the chest (pectoralis) muscle, directly under the skin and subcutaneous tissue (the layer of tissue just under the skin). This is called a prepectoral implant reconstruction. The whole of the implant is covered by a dermal matrix or mesh to hold the implant in place. Your surgeon will discuss the most suitable method for you.

Two-stage operation

In the first operation a balloon-like bag called an inflatable tissue expander is placed under the skin and often beneath the chest muscle. In some cases, it can be placed in front of the chest muscle. Every couple of weeks, the balloon is injected with saline through a port (a thin tube with an opening just under the skin). You may be given 1–6 injections depending on how much the skin and muscle need to stretch. The stretched tissue creates a pocket for the breast implant.

When the expander has stretched the tissue enough, the surgeon removes the temporary expander and replaces it with a permanent silicone or saline implant in a second operation. You may need to stay in hospital overnight after this second operation.

Stages of delayed breast reconstruction with a tissue expander

	Before the tissue expander process The chest tissue is mostly flat, because breast tissue and skin was removed during the mastectomy.
	Implanting the tissue expander Inserting the tissue expander creates a pocket for the implant. There is a port through which the saline can be injected. The saline injections usually cause little pain.
	Expanding the tissue expander The tissue stretches and expands each time saline is added. You may feel discomfort for a few days. When the expander has stretched the tissue enough the expander is removed and the implant is inserted in its place.

Acellular dermal matrix and synthetic mesh

If there is not enough tissue to cover the entire implant other material called acellular dermal matrix (ADM) is used. This may be made from animal (cow or pig) or human tissue.

The ADM is processed and sterilised for use in surgery. It is cut to size and modelled to the shape of the breast. Sometimes a synthetic mesh is used instead.

When in place, the ADM or mesh works like building scaffolding – it is there to support and contain the breast implant. Your existing skin will grow into the ADM or mesh as the area heals.