Advanced Breast Surgery Techniques

After a mastectomy, the skilled plastic and reconstructive surgeons at Skagit Regional Health use the latest techniques to rebuild the breast and give patients a more natural appearance.

When to Have Breast Reconstruction

If you’re a woman considering breast reconstruction, you will need to discuss with your doctor when to have the surgery and what type of surgery to have. Your plastic and reconstructive surgeon will help you weigh the risks and benefits to determine the best timing for your breast reconstruction surgery. You may consider one of two options:

Simultaneous or single-stage breast reconstruction: Women with smaller breasts may have the option to pursue breast reconstruction at the same time they have their mastectomy.
Staged breast reconstruction: Your surgeon will place a silicone pouch called a “tissue expander” underneath the chest muscle to gently stretch your skin and soft tissue. The tissue expander has a valve that allows your surgeon to slowly fill it with saline (salt water) over the course of many months. This will enlarge the space under the pectoral muscle to allow for a breast implant to be inserted during a second surgery.

Types of Breast Reconstruction

Skagit Regional Health offers women the option of implant reconstruction or natural tissue reconstruction.

Implant Reconstruction

Breast implants are round or tear-drop shaped silicone shells filled with saline (salt water) or silicone gel. They are placed underneath the pectoral muscle.

Saline implants: The majority of breast implants are saline-filled implants.
Silicone implants: Many people prefer the look and feel of silicone implants, as the texture of the gel is similar to natural breast tissue. However, if a silicone implant ruptures, it is more difficult to detect and repair than a saline implant.

Advantages of Implants

Patients who choose to have implant reconstruction typically have fewer scars. Your reconstructive surgeon is often able to use the scar from your mastectomy for your implant, so no new incisions will be made.
Surgery and recovery times for patients who choose implant surgery are typically less than those who choose natural tissue reconstruction.
Surgical results are more predictable due to the predetermined shape of the implants.

Disadvantages of Implants

Implants come in predetermined shapes, making it more difficult to match the look of your other breast.
Implants do not change in size or shape, even if you do. If you gain or lose weight, your breast may appear disproportionate to the rest of your body.
Implants have the potential to leak, at which time the implant would need to be removed or replaced. Rupture occurs in approximately 10 percent of women during the first 10 years after surgery.
Infection is possible, as you are adding a foreign object to your body.
Patients who have undergone radiation may not respond well to the process of tissue expansion. Radiation can cause scarring, making skin less able to stretch to accommodate the implant.
Scar tissue can form around the outside of the implant, making the breast feel hard. Another surgery would be necessary to replace or remove the implant.
The implant can shift, causing a wrinkle or dent in the shape of the breast.
The process of using a tissue expander can be time-consuming. It requires frequent visits to your surgeon’s office and more than one surgery.

Natural Tissue Reconstruction

Natural tissue reconstruction uses tissue from your own abdomen, buttocks, thigh or back to recreate your breast. The Transverse Rectus Abdominis Muscle (TRAM) Flap Reconstruction uses skin and body fat from your lower abdomen and is the most common type of natural tissue reconstruction.

Advantages of Natural Tissue Reconstruction

Implant surgery often requires two surgeries, whereas natural tissue reconstruction can be immediate (at the time of mastectomy) or delayed.
Natural tissue is used to create the breast, so it better reflects changes in your weight by growing or decreasing in size as you gain or lose weight.
Use of your own tissue in reconstruction eliminates the possibility of needing an implant replaced later.
Your reconstructive surgeon can sculpt your tissue to create a breast that resembles your other breast.

Disadvantages of Natural Tissue Reconstruction

A small number of women experience tissue loss in part or all of their new breast or other complications.
An additional surgery may be needed to revise the breast shape.
You have an additional scar where tissue was removed to create the new breast.
This is a complex surgery. Reconstruction takes more time on the front end when compared to implant surgery, and recovery time is longer (six to eight weeks).