Breast implants, both saline and silicone, have been used for breast
reconstruction for more than thirty years. At first, that was all
that was available to rebuild a woman's breast after mastectomy.
In the late 1970's, with the introduction of the TRAM flap, that changed
.
While surgical techniques for putting in an implant have evolved,
and the outer shell and inner filling of an implant have changed over
the years, the problems associated with breast implant reconstruction in
a patient who has undergone a mastectomy remain the same.
The above patient
underwent mastectomy and implant reconstruction by another doctor.
There was capsular contracture and displacement of the implant which
left her with the result on the left. The implant was removed and
she underwent DIEP flap reconstruction with lifting of the other breast
to obtain the final result on the right.
Breast implants are "safe" according to the best information
available today. That does not mean that the body does not react
to this foreign material. The bed that an implant is placed, in a
woman who has had a mastectomy, is scarred and missing skin. The
body reacts to the breast implant by isolating it (forming a capsule or
scar around the implant) and then trying to squeeze it into the smallest
possible space.
The above 51 year
old underwent bilateral mastectomies and implant reconstruction 11 years
ago. While initially the reconstructions were "good",
over the years the breasts became harder, painful, and changed
shape. Despite the fact that this patient was a diabetic, she was
able to undergo removal of both implants and bilateral DIEP flap breast
reconstruction. At the time of the surgery it was discovered that
one of the silicone implants was ruptured.
Both implant manufacturers and plastic surgeons take elaborate steps
to try and modify this normal reaction of the body. Therefore, a
breast reconstructed with an implant can become hard, contracted, and misshapen.
The firmness can also be uncomfortable in many women.
With the DIEP flap there is no reaction by the body because no
foreign material was used.
Copyright 2000-2007 Alex Keller, MD, FACS. pc. All
rights reserved.
