Breast reconstruction with an expander prosthesis / fat transfer
A silicone implant is a good option for a slim patient who does not have enough tissue of her own to be used for breast reconstruction. It is common for the mastectomy scar to be a little tight, and therefore it needs to be gradually stretched. A pocket is made under the pectoral (chest) muscle and an empty tissue expander is inserted into the pocket. An acellular dermal matrix is usually used to support the lower portion of the expander prosthesis (see Reconstructive surgery).
After the incision has healed, the process of gradually filling the expander prosthesis with saline solution is started. Saline solution can be added to the expander 1-2 times a week, depending on the flexibility of the skin and the scar. The expander is filled until it is slightly larger than the planned implant. Once the expansion is complete and the skin tightness has returned to normal, the tissue expander is exchanged for an implant.
Finally, a nipple is reconstructed using a skin flap and, once these incisions have healed, an areola is tattooed around the reconstructed nipple.
These surgical procedures are usually performed as day surgery, after which the patient needs 1-2 weeks of sick leave.
Breast reconstruction using fat transfer
Reconstructing a breast with autologous fat transfer is an interesting, relatively new technique. The patient’s own fat tissue is harvested from other parts of the body by gentle liposuction (see Reconstructive surgery).
To build up a whole breast, 3-4 fat transfer procedures are needed. The procedures are usually performed as day surgery under general anaesthesia.
Breast reconstruction with fat transfer is often preceded by tissue expansion. This can be done with an expander prosthesis, or with an external tissue expander, i.e. a mechanical suction bra (Brava method). The external suction bra must be worn for several months, and fat tissue is added to the breast as the skin stretches. The method requires patience and commitment in order to achieve the desired result.