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Implant Vs. Tissue Flap Reconstruction: Part III

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In this third and final installment of my implant versus tissue flap reconstruction blog series, I’ll highlight the advantages and disadvantages of flap reconstruction. If you need to catch up, check out “Implant Vs. Tissue Flap Reconstruction: Part II.”

Advantages of Flap Reconstruction

There are many options for flap reconstruction surgery, the most technologically advanced of which include Reconstructive Microsurgery and preserving major muscles of the body. The DIEP flap and SIEA flap taken from the lower abdomen and the TUG flap taken from the upper inner thigh region are examples of options offered to patients at my practice. Some advantages for flap reconstruction include:

Most women are only offered the traditional two-stage tissue expander and implant reconstruction where a flat tissue expander is placed below the pectoralis muscle at the time of mastectomy, slowly inflated and then over-expanded for many months, and then exchanged for a permanent implant at a later date. Finally, a nipple prominence is created and an areola is then created in the third and/or fourth procedures.

The problem with traditional submuscular techniques includes significant pain during the expansion process and the possibility of chronic muscle pain or strain due to tension of the implant under the muscle; a “motion deformity” that is created each time the pec muscle flexes; the implants tend to sit high or wide on the chest; and multiple surgical stages are required to reach the final result (which can take a year or more to achieve). For these reasons, I sought to offer an alternative for women and am happy to say there is another option that can produce excellent aesthetic results without the muscle-related problems!

I use a special permanent, yet postoperatively-adjustable implant for breast reconstruction that can remain as the final implant if desired. The implant is inflated to approximately 60% of the total volume at the time of the mastectomy with saline, and only one or two inflations are generally required after surgery starting at one to two weeks postoperatively. The implant is generally completely full by one month after mastectomy, with a natural result that is carefully tailored and adjusted after surgery to a woman’s body and aesthetic desires. The saline implant can then be exchanged for a silicone implant at around three months if we feel that a better result can be obtained by changing the type of implant.

Why can’t we just insert a silicone implant at the time of mastectomy? The adjustable implant must be saline-filled in order to avoid too much tension on the skin and to tailor the results to each patient during the reconstruction. Silicone gel implants are a fixed volume that cannot be adjusted. Many patients are very pleased with their results of the saline implants and only the “port” (injection dome) needs removal during a short outpatient procedure any time after three months. However, the option exists to exchange the saline implant to a silicone gel device at the time of port removal if we feel it would provide the very best results. I make this decision together with my patients and discuss all the options with them at every stage in their journey, from initial consult to final procedure.

To learn more about single-stage immediate implant reconstruction, or to find out if you are a good candidate for my unique technique, please contact our office today.



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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA