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Single Stage Implant Breast Reconstructions Becoming Real

Dr. Lokesh Kumar | April, 18 2016 | 0 Comments

There was once a time, when cancer was a rare occurrence and the people who were afflicted by it, did not even know in time, how to combat it. Today, however, the truth is a different one and the number of registered cases of cancer is not only staggering but also incredibly scary.  For women, it is breast cancer that is the scariest prospect, because there is a possibility that they might lose their breasts, which is an essential part of their physical identity.

In most cases, where the cancer is diagnosed in the breast, there is often no option but to undergo mastectomy. However, in the recent few years, there has been a lot of research and studies on how to bring such women back to a life of physical normalcy. One of the positive steps in this direction is breast reconstruction, but in the past, breast reconstruction also has been a long winded process.

Now, a growing number of surgeons are looking at one step approaches towards breast reconstruction, as these not only reduce the downtime for the patient, but also the medical costs being incurred. Today, there are several women who are ideal candidates for what is being called as the “one and done” approach or the single stage implant breast reconstruction method.

The main benefits of single stage implant breast reconstruction include:

  • Lesser visits to the doctor
  • Faster return to a normal life
  • Restoration of normal looking breasts
  • Proper creation of the areola

The process is actually quite straightforward – the cancerous breast tissue is removed and as much of the healthy breast tissue as possible, is preserved. In addition, the nipple as well as the surrounding tissue is also preserved. Natural skin from the breast will be used immediately to recreate the breast. New methods include the usage of breast implants which are shaped like teardrops, along with a biomaterial known as acellular dermal matrix. The latter acts as a support system for the new breast and also helps with the growth of new tissue. In certain cases, fat needs to be used to create breasts that are more aesthetically pleasing.

Since two procedures are being combined, not only is the cancer removed, but the breast is also reconstructed. Doctors are of the opinion that this not only reduces the amount of time that the patient has to be under physical stress, but also the psychological aftermaths. The latter is mainly because the patient is able to return to a life of normalcy immediately.

Now let’s look at single stage implant breast reconstruction in detail:

There are some obvious benefits to choosing implant based reconstruction of breasts and some of the most prominent ones include:

  • Lesser time taken for the actual surgery
  • The almost non-existence of donor site morbidity
  • Faster return to normalcy

Now, with single stage implant breast reconstruction or single-stage direct-to-implant (DTI) breast reconstruction, the benefits are even greater, because the breast is recreated within minutes of the mastectomy. In the past, direct to implant breast reconstruction was avoided because there are worries related to improper positioning of the implant, muscle retraction and contracture. Today, however, things have changed, because pockets are created around the implant, and these pockets handle all the stretching and contracting that the muscles might do.

The indications for single stage implant breast reconstruction:

The process has to start with patient selection, because not everyone will prove to be a worthy enough candidate for the procedure. The overall health of the patient has to be taken into consideration:

  • Non-smoker
  • Existing breast size should be small to medium
  • The desire should be for a breast size that is similar to the existing size
  • Nonexistence of any serious medical conditions
  • No pre-existing scars on the breast
  • Condition of the skin and the structure as well as texture of the same

The actual procedure of single stage implants breast reconstruction:

Initial markings will be made with the patient standing up and the initial incisions will also be decided at this point. The aspects which will decide the location of the incisions will include:

  • The inframammary fold
  • The relation of the inframammary fold between the two sides
  • The lateral borders of the breast

The patient will be given medication to relax the muscles, which will allow for easier dissection of the subpectoral region. In order to ensure that the implant is easily inserted and there are no issues with the positioning incisions will be made to divide the muscles. After the muscles have been divided, the acellular dermal matrix will be used to create the borders and this will be sewn in. In case the size of the matrix is not sufficient, a serratus flap will be used and a sizer will be used to adjust the size of the pocket that has been created.

The decision on the final implant will be made, after the incision has been closed temporarily and the patient has been made to sit upright. Once the appropriate sized implant has been placed, the pocket will be closed. Suction drains will be placed alongside the inframammary fold as well as the axillary region. Finally, the mastectomy skin will then be trimmed and tightened. The patient will be asked to wear surgical bras for a few weeks, post-surgery. While the drains will be removed in the following weeks, activity will not be allowed for a minimum of five to six weeks.

What can be expected from a single stage implant breast reconstruction:

  • The chances of skin necrosis are minimal, however, there have been a few cases of the same that have been reported.
  • The spaces that are created have to be drained out, or else there is an elevated chance of infection.
  • The complication rate is incredibly low

Dr. Lokesh Kumar

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