Prophylactic Mastectomy with Primary Expander ImplantsMedical editor Ellen Schlichting MD
Oslo University Hospital
Haakon Christian Korvald
Oslo University Hospital
The timing of riskreducing mastectomy should be meticuously discussed with each patient as we know the riskincreases from the age of 25 years. For the majority this can be adequately performed around 30 years of age.
- Known mutations of BRCA 1.
- For mutation of BRCA 2 or hereditary breast cancer without a known gene mutation (the indication is not as clear as for BRCA1 mutation, because the prognosis is as good as in sporadic breast cancer).
- To avoid development of breast cancer.
- In some cases, the goal may be to reduce the number of follow-up examinations and possible complications associated with these.
- Microsurgery tray
Preoperative outline of the skin incision with the patient sitting upright.
The operation is performed under general anesthesia.
The patient lies in the supine position.
Bilateral skin-sparing mastectomy
- The surgery is initiated on one side.
- A boat-shaped incision is made including normally the areola, but it can be preserved when the patient wants it.
- After suturing, the scar should be horizontal and not askew into the axilla.
- The skin is spared as much as possible.
- The breast with surrounding tissue is removed down to the pectoralis muscle, sparing the fascia.
- The same procedure is carried out on the contralateral side.
Reconstruction with expander prosthesis
A plastic surgeon performs the reconstructive part of the operation.
- A sub-muscular pocket is made in the midline deep to the pectoral muscle and the serratus fascia.
- Thorough hemostasis is performed.
- One or two vacuum drains are positioned and fixed.
- The expander prosthesis is inserted.
- The muscle is sutured.
- The skin is closed in two layers.
- The procedure is repeated on the remaining side.
- Both expanders are filled with saline (the volume depends on skin circulation).
- Dry bandages are applied.
- The drains are activated.
- The drains are removed according to the surgeon, usually when 20-30 ml drains during the 24 hours.
- The patient is discharged usually after 2-4 days.
- After 4-6 days, the bandage is removed and a soft bra can be worn.
- The first refilling of the expanders is done 2-3 weeks after the operation.
- Further filling is done at intervals of 1-2 weeks. The number of refills and volume depend on the size of the breast.
- The expander implants are exchanged for silicone implants later, usually after 3 months.
- The patient is informed of the possibility for reconstruction of the areola.