Mastectomy with Primary ImplantMedical editor Ellen Schlichting MD
Oslo University Hospital
Haakon Christian Korvald
Oslo University Hospital
Reconstruction with a simple implant is preferred to reconstruction using the patients own tissue. For patients who will later have radiation therapy, radiation therapy can make the cosmetic outcome some worse, but nevertheless we consider reconstruction with an simple implant to be preferred to own tissue reconstruction.
There can be used an expanding implant which can be changed for a permanent implant later or there can be used a permanent implant immediately. By using an expanding implant, a collapsed implant is placed and gradually filled with saline through a syringe, weekly in the time after surgery.
Primary reconstruction with implant can be offered to patients who need to remove the breast of medical reasons or who themselves wants to remove the breast (mastectomy). The patient must be a non-smoker and other health premises may also be appropriate to have a implant reconstruction.
To carry out reconstruction of a breast in the same operation as the mastectomy.
- Tray for fine surgery
- Implant (different types of implants should be available)
- Two drains
- Possible catheter to deal with pain
- Breast bandage.
- Thromboprophylaxis by indication.
- Armpit is shaved.
- The operation is performed under general anesthesia.
The patient in a supine position with the ipsilateral arm abducted 70-90°.
- An elliptical skin incision including the areola complex is done after the outlining. The cut is sharply done through the skin after the outlining.
- Mammary gland is released from surrounding tissue down to the pectoralis major.
- Gland and possibly facies over the muscle is removed.
- Hemostasis is controlled.
- A void is created under the large breast muscle and appropriate implant size is entered.
- By use of an expanding implant, some saline is being sprayed into the implant.
- Commonly two drainages are used.
- Layered closure.
- A bandage and breast bind is applied.
Choice of procedure may vary between hospitals.
The patient is usually hospitalized for a few days postoperatively, and receive follow-up on pain and information about the use of the arm.
In case the patient has got expanding implants, the refilling of saline starts-up.
Check-up with breast surgeon circa 3 weeks postoperatively for information on histology answer and possible need for adjuvant treatment.
Further follow-up as required for refilling of the expanders and replacement to permanent implant.