A breast reconstruction with an implant or tissue expander is a surgical procedure that aims to recreate a breast shape after a mastectomy. During this procedure, a surgeon will use either a breast implant or a tissue expander, which is an expandable implant, to reconstruct the shape of the breast. This process helps to restore a sense of normalcy and confidence for individuals who have undergone a mastectomy. The choice between a breast implant or tissue expander will depend on various factors, including the patient’s anatomy, desired outcome, and overall health. Ultimately, the goal of a breast reconstruction is to help individuals feel whole and comfortable in their bodies following breast cancer treatment.
When facing breast reconstruction surgery, it’s natural to have a lot of questions and concerns. You may be wondering about the specifics of the surgery, the recovery process, and whether or not your insurance will cover it. However, one of the most crucial aspects to consider is what options are available to you for reconstruction. There are several different techniques and procedures that can be used to reconstruct the breast, each with its own benefits and considerations. It’s important to discuss these options with your healthcare provider to determine the best course of action for your individual needs and preferences. By understanding your options and making an informed decision, you can feel more confident and empowered as you move forward with your breast reconstruction journey.
In this article, we will consider sleeping with tissue expanders and tissue expander exchange surgery recovery time.
Breast Reconstruction Surgery With Tissue Expander
Breast reconstruction surgery can be performed in several different ways. It depends on your specific needs and preferences. Here are three options:
- Autologous tissue transfer, also known as “microvascular” or “free flap” reconstruction, uses your own tissue to rebuild the breast area. The procedure involves moving skin and fat from other areas of your body (usually from behind your armpit) to create new breast tissue. This option is best suited for patients who have had lumpectomy surgery but still want to retain their nipple and areola and have enough healthy tissue in other parts of their body to use in reconstruction.
- Implant-based reconstruction involves placing an implant into a pocket created underneath your chest muscle or above your muscle with liposuction. This option is best suited for patients who have had lumpectomy surgery but still want to retain their nipple.
What is a breast reconstruction with an implant or tissue expander?
A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy (removing all your breast). Your surgeon will use a breast implant or tissue expander (expandable implant) to recreate the shape of a breast.
What kind of breast implant should I choose?
All implants are made of an outer layer (shell) of silicone or polyurethane. They can be filled with silicone or saline.
Softer silicone and saline implants give a softer and more natural feel but are more prone to kinking or rippling.
More cohesive silicone implants give a firmer feel, hold their shape more and are less prone to kinking or rippling.
If you have already had a mastectomy, your surgeon may need to use a tissue expander. Over a number of weeks your surgeon will gradually fill the tissue expander with saline through a small tube (port) to stretch your skin and make your breasts similar in size.
Is silicone safe?
There is no evidence to suggest that women with silicone breast implants have a higher risk of developing diseases such as breast cancer and arthritis.
There is a reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma (ALCL) but the increase in risk is small and ALCL in this area is not as serious as it is when it happens elsewhere in your body.
What are the benefits of surgery?
You should get a breast shape again. Most women who have a successful breast reconstruction are more comfortable with their appearance.
Are there any alternatives to a breast reconstruction with an implant or tissue expander?
Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.
It is possible to use tissue from another area of your body, usually your lower abdomen or sometimes from your buttocks, inner thigh or side.
A reconstruction can be performed using the latissimus dorsi muscle that is moved from the side of your back and used to recreate a breast shape.
What does the operation involve?
The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.
If you have already had a mastectomy there is usually not enough skin to recreate a breast shape so you will need a tissue expander to stretch your skin. Your surgeon will make a cut on the front of your chest over the mastectomy scar, or at the lower end of your new breast. They will create a pocket under the muscle to place the tissue expander in.
What complications can happen?
Some complications can be serious and can even cause death.
General complications of any operation
- Pain
- Bleeding
- Infection of the surgical site (wound)
- Allergic reaction to the equipment, materials or medication
- Unsightly scarring of your skin
- Blood clot in your leg
- Blood clot in your lung
Specific complications of this operation
Breast reconstruction complications
- Developing a lump under your wound caused by fluid collecting
- Developing a lump under your wound caused by blood collecting
- Wound breakdown, where a wound fails to heal and opens up
- Skin necrosis, where some of the original breast skin at the edge of your wound dies leaving a black area
- Difference in shape and appearance
- Numbness or continued pain around your armpit or the inner part of your arm
- Permanent numbness around the scar on your chest
Implant complications
- Developing a collection of fluid (seroma) in the pocket where the implant is
- Capsule contracture, where scar tissue that your body naturally forms thickens and tightens around the implant
- Rupture of an implant
- Kinking and rippling
- Infection of the implant
- Failure of the reconstruction.
Tissue Expander Exchange Surgery Recovery Time
How soon will I recover?
You should be able to go home after 2 to 3 days.
You should be able to return to normal activities after 4 to 6 weeks.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.
If your surgeon needed to use a tissue expander, you will need to come back to the clinic regularly.
The shape of your reconstructed breast takes several weeks to settle.
A breast reconstruction with a breast implant or tissue expander is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.
Nipple reconstruction surgery is a procedure in which a surgeon reconstructs the nipple after a mastectomy, or surgical removal of the breast.
After a mastectomy, a person may decide to have breast and nipple reconstruction surgery. Others may have breast but not nipple reconstruction. Other options include wearing a prosthetic breast or simply “going flat.”
The choice is entirely up to the individual, assuming that they are healthy enough for reconstruction, and that their tissue has healed well following the mastectomy.
This article covers the different types of nipple reconstruction surgery, how to prepare, and what to expect during the recovery process. We also discuss the potential side effects, complications, and costs.
Types of nipple reconstruction
Depending on the size and location of the cancer, as well as the size of the breast, some people have the option to undergo a nipple sparing mastectomy. If a person has a total mastectomy, they may choose to have breast or nipple reconstruction.
During nipple reconstruction surgery, a surgeon will use skin from the breast or another part of the body to rebuild the nipple on top of the breast mound. They will try to build the new nipple to match the size, shape, and color of the original one.
People can speak with their healthcare provider about the potential costs and benefits of this procedure.
There are several different types of nipple reconstruction surgery. Surgeons will take people’s condition and personal preferences into account when advising on which method may be best.
Types of nipple reconstruction method include:
Skin flap reconstruction
A surgeon can raise small flaps of skin from around the area where the intended nipple location is to be. They will then fold and sew together these skin flaps above the level of the surrounding skin, creating a bump that will become the new nipple.
According to one 2015 article, nipples that surgeons build using the skin flap method can retract or flatten over time. This is not harmful, but if people choose to, they can have a second procedure to resolve this.
Skin graft reconstruction
To create a nipple from a skin graft, a surgeon will take a small piece of skin from a different part of the body — such as the inner thigh, stomach, or buttocks — to create the areola. Depending on the amount of available skin tissue, they may be able to construct the nipple from the skin of the breast mound.
This procedure works well if there is not enough skin tissue on the breast mound to create both the nipple and the areola.
One 2018 study suggested that skin graft techniques can provide the best match for the color and texture of the natural nipple.
Like in the skin flap method, nipples that surgeons make from a skin graft may become flatter over time.
Medical tattooing
Once healed, a person may choose to get a medical tattoo over the top of a reconstructed nipple to make it look more natural. This can help create the pigmented areola.
A person can also choose to skip nipple reconstruction surgery and get a nipple tattooed directly onto the breast mound. There have been many recent improvements in nipple tattoo techniques. One example is 3D tattooing, which uses shading and shadow to create the appearance of a raised nipple.
How to prepare
According to the American Cancer Society (ACS), nipple reconstruction surgery usually takes place 3–4 months after breast reconstruction surgery, giving the new breast time to heal.
A doctor may ask the person not to consume any food and water on the night before the procedure. They may also recommend that the person stops taking certain medications for some days leading up to their procedure.
Sometimes, however, a surgeon can perform the procedure using only numbing medicine on the breast.
Recovery
While the nipple heals, it might look more erect than usual, but it should flatten a little over time. People can also expect some tenderness in the new nipple as it heals.
People may use a plastic nipple protector and a surgical bra to protect the new nipple from injury. A surgeon or nurse will give people specific information regarding:
- how long to wear the bra and bandages
- how to care for and clean the new nipple
- when to return for the postsurgical exam
During recovery, a person should try to avoid using soaps that contain harsh chemicals when cleaning the new nipple. People can apply antibacterial ointment to the healing nipple to avoid infection.
However, it is always best to check with a doctor before using any new medications or ointments.
Side effects
The ACS list the following possible side effects of nipple reconstruction surgery:
- bleeding
- swelling from fluid buildup in the breast
- infection at the site of the surgery
- fatigue
Complications
Although they are rare, compilations can occur following nipple reconstruction surgery. Complications may include:
- nipple flattening or retraction
- changes in the appearance of the nipple or breast
- loss of sensation in the nipple or breast
- changes in the appearance or sensation of the arm
- necrosis, or tissue breakdown
- loss of pigment from nipple tattooing
Costs and insurance coverage
The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires most private health insurance companies to cover every stage of breast reconstruction surgery.
This includes additional procedures to treat any complications that arise.
The WHCRA applies to two types of plans:
- group health plans, such as insurance that employers or unions offer
- individual health insurance policies
Medicare covers breast reconstruction surgery, while Medicaid coverage differs from state to state.
Insurance might not cover the cost of nipple tattooing that a nonmedical professional, such as an independent tattoo artist, performs.
Nipple reconstruction surgery involves rebuilding the nipple and areola on top of the breast mound. This procedure usually marks the final phase of breast reconstruction surgery.
A surgeon can use skin from the breast mound, thigh, stomach, or buttocks to form the nipple and areola.
The new nipple may flatten or retract over time. If this happens, people can choose to have another procedure to reshape the nipple.
Sleeping With Tissue Expanders
Sleeping with your head slightly elevated above your body serves as a dual benefit, so use multiple pillows to achieve this. First, if you use two or three pillows to prop up your head and neck, you’ll have a harder time rolling over into a side or stomach position during the night, even unintentionally. As the swelling is reduced by being in an elevated position, you may find it more comfortable.
Do What You Can to Improve Your Sleep
Most of the repair work your body does happens while you’re sleeping. As a result, getting enough shut-eye must be a top priority. Avoiding coffee, tea, sodas, and chocolate in the evening can help you get to sleep faster and stay asleep longer. Adjust the temperature to your preference, and make sure you have clean sheets. Do not use electronic devices an hour before bedtime because the blue light they emit can interfere with sleep.