Breast Reconstruction

Breast Reconstruction

After a mastectomy, when very thin soft tissue covers the chest wall, complications are more common (such as infections and exposure of the implant to external factors), often resulting in below-average outcomes. To overcome this, a fat grafting technique known as “lipofilling” is performed before reconstruction to increase the thickness of the tissues covering the implant. This method significantly improves results and reduces complications, allowing more patients to undergo reconstruction with implants and reducing the need for flaps.

Fat is harvested through liposuction (from the abdomen, hips, or thighs) and then injected under the chest skin before placing the implant. Usually, two lipofilling sessions are needed to achieve satisfactory results.

Types of Breast Implants

Silicone gel-filled implants are the most commonly used because they provide better results. Although they raised concerns among international medical authorities in the past, several scientific studies have since confirmed their safety and reliability.

There are two main types of implants:

  • Anatomical (teardrop-shaped) implants that can be selected based on width, height, and projection.
  • Round implants.

In breast reconstruction, anatomical silicone gel implants are mainly used, while round implants may be used to increase the size of the opposite breast if needed.

Expandable implants allow gradual stretching of the tissues. They are initially placed empty, and once the skin and muscle heal, the surgeon fills them with saline through a valve under the skin to increase their size.

Surgical Procedure

  • The surgeon makes an incision along the mastectomy scar.
  • A pocket is created behind the chest muscle (the space for the implant).
  • The inframammary fold (under-breast crease) is recreated.
  • The implant is inserted along with a drain to remove fluids, which is removed after a few days.
  • The skin is then closed.
  • If necessary, surgery may also be performed on the other breast (enlargement, reduction, or lifting) to achieve symmetry.

Practical Details

  • Duration: 1.5 to 2.5 hours
  • Anesthesia: General
  • Hospital stay: From 24 hours (overnight) up to one week depending on the patient’s situation
  • Pain: Usually moderate and well controlled with painkillers
  • Dressings: Kept for 8–10 days
  • Physical activity: Avoided for about one month
  • This surgery is usually covered by health insurance

Possible Complications

  • Risk of infection due to the presence of a foreign body, increased with radiotherapy
  • The scar area may be weak, and radiotherapy can increase the risk of poor healing
  • Formation of a capsule (scar tissue) around the implant; the firmness of this capsule affects the quality of the reconstruction. A harder capsule (capsular contracture) leads to a firmer, less natural result. Radiotherapy also increases the risk of this condition.