What body factors impact expander vs. direct to implant breast reconstruction?

I agree with Dr. Wallach, there are many decisions pre- and intra-operatively that need to be made in order to make sure that the direct to implant reconstruction is safe for you. If they decide that direct to implant is not safe, they can use an expander with the Alloderm, allowing the expander to be filled quite a bit in the OR and the expansion time is dramatically decreased.

The breast tissue has to be removed and then the cavity filled with the implant.  The natural borders of the breast tissue have been removed so material like alloderm is used to help re-create these borders.  Although this sounds simple it is quite complicated and preserving blood flow in the tissues during these procedures can be the main issue that results in loss of some of the breast skin and that can lead to exposure of your implant or an infection more commonly.Three
basic forms of breast reconstruction exist. You can use your own tissue,
implants or a combination of the previous two techniques. Your own tissue can
be used in the form of the DIEP flap, PAP flap, SGAP flap or fat grafting.
Implants can be done in one stage or two stage. Two stage reconstructions are
started by placing expanders at the time of mastectomy. Once they expanders are
placed they are able to be inflated as determined by wound healing. The final
time consists of combining any of the above techniques.



If
you are interested in being seen in Austin please give us a call. I know
this is a difficult time for you. The majority of my practice is devoted
to reconstruction for women with breast cancer or who are BRCA+

There are many factors that go into direct to implant reconstruction. This includes the location and size of the tumor, whether or not there is a positive biopsy under the nipple and areola, the size of the breasts( and significant ptosis), to name a few. The breast surgeon along with the plastic surgeon can guide you, but expanders should always be available jsut in case this is not an option.

The advent of skin sparing and nipple sparing mastectomy enables direct to implant reconstruction without the need for expansion.However the implant may cause pressure on the skin flaps compromising the circulationthere is another option without expansion,the adjustable breast implant.This implant can be placed under-filled initially and then filled a few days later once circulation is assuredSee attached link

firstly I would like to say I sympathize with you and I appreciate the fact that you would like to get this behind you. I wish you the best of luck in getting this behind you.The use of cadaver skin – Alloderm – and either implants or tissue expander's is an operation in breast reconstruction that has a significant complication rate as well as variable Aesthetic results. It will probably someday be viewed as a less popular way to reconstruct a breast.Having said that, there are probably two body factors that are the most important in determining whether you will wake up with implants or tissue expander these are –1- the size of the opposite breast that the surgeons are trying to match. The larger the breast they're trying to match, the larger the implant they need to use and There may not be sufficient room underneath the muscle or inadequate skin and soft tissue at the time of the mastectomy. This would mandate the use of tissue expansion.2- The clinical status of the lymph nodes at the time of surgery. The higher the likelihood that you might require radiation postoperatively, the more one might lean towards tissue expansion. This is because the expander can be placed relatively empty and gradually increased after you complete your radiation. If you have a permanent implant placed at the time of surgery, and then have radiation, there is a high likelihood you will get a capsular contracture and tense scar around this implant.Now you can go back and reread paragraph two and see why I often ask the same question you asked. The future of breast reconstruction will involve more autologous fat transplantation either alone to reconstruct the breast, or used with implants – composite breast reconstruction. I have attached a link for your review. I hope this helps.Best regards,Dr. DelvecchioBostonbreastcenter.com

As a plastic surgeon, when I plan breast reconstruction with the breast surgeon in a nipple sparing mastectomy. First I have to give all the freedom to the general surgeon to do the appropriate procedure to get rid of the breast cancer. That also involves how thin the skin flaps are that are left by the surgeon. At the end of the nipple sparing mastectomy, I, as a plastic surgeon, have to assess the viability of the skin, the nipple areola, and the thinness of the skin flaps. Then I have to get rid of all non viable tissue, and decide with what is left behind , what is the best way to reconstruct that breast safely.All these issues should be discussed with you before the surgery. There should be no surprises or very little. Samir Shureih MD. FACSsshureih@msn.com

The reconstructive surgeon follows the ablative surgeon- what the reconstructive surgeon can do is dependent on how the tissues look after the mastectomy - therefore your reconstructive decision may be made then but you should be informed of all options prior including autologous tissue reconstruction