Breast Reconstruction

Reconstruction With Implants

Breast reconstruction with implants is typically done using tissue expanders, which are placed at or within weeks of the mastectomy. Tissue expansion stretches healthy skin to provide coverage for an implant. Reconstruction with tissue expansion allows an easier recovery than flap procedures, but it is a more lengthy reconstruction process. The implant is expanded distantly after placement through an internal valve to expand the skin. A second surgical procedure will be needed to replace the expander, as it is not designed to serve as a permanent implant.

Breast implants can be used in combination with or as an alternative to flap techniques. There are many different types, shapes, sizes, and brands of implants available. During the consultation process, you’ll work with your surgeon and our phenomenal nurses to find the right implant for you. You may also “test out” the implants with our Vectra 3D imaging system, which allows you to visualize your potential results. Depending on your needs and goals, Dr. Janssen or Dr. Doubek may recommend adding fat grafting and nipple and areola reconstruction to your surgical plan. Sometimes the nipple and areola are tattooed instead of reconstructed.

Implant Placement

At Fox Valley Plastic Surgery, we perform pre-pectoral reconstruction, which means that implants are placed over the chest muscle rather than beneath it. This modern approach has become increasingly popular as patients who underwent prepectoral implant reconstruction report higher satisfaction scores in physical and psychological well-being compared to traditional submuscular techniques, according to a 2024 study published by Dr. Janssen, Dr. Doubek and others in the Journal of the American Society of Plastic Surgeons. Additional research has also shown that pre-pectoral reconstruction offers full pectoralis muscle preservation, reduced loss of strength, reduced pain, and elimination of animation deformity.

One & Two-Stage Reconstruction

Breast reconstruction with implants can be accomplished in one or two stages:

• Direct-to-implant reconstruction: The benefit of direct-to-implant reconstruction (also called one-stage reconstruction) is that it usually requires only one surgery. There are specific parameters to be a good candidate for one-stage reconstruction.
• Tissue expander-to-implant reconstruction: This is the most common type of breast implant reconstruction. An expander is placed beneath the skin and muscle. The expander is gradually filled with a saline solution to increase its size. After the skin and muscle over the breast have stretched enough to form a pocket to house the implant, a second procedure removes the expander and places a permanent silicone or saline implant into the newly expanded space.

Recovery

Recovery varies significantly depending on the type of reconstruction you have. Implant-based procedures generally involve a shorter recovery than flap reconstruction, though both require patience and careful attention to your surgeon’s instructions.

For implant-based reconstruction, surgery and recovery typically occur in two stages. Stage one involves the placement of a tissue expander at some time after the mastectomy. Patients are generally able to return to work in three to four weeks. Stage two involves the removal of tissue expanders and the placement of permanent implants, which is performed as an outpatient surgery. For each stage, pain is usually manageable with prescribed medication, and discomfort improves steadily as healing progresses.

Flap reconstruction involves a longer recovery because you’re healing two surgical sites: the breast and the donor area. Most patients take four to six weeks off work. You’ll have drains at both sites, and activity restrictions are more extensive to protect the delicate blood supply to your new breast tissue. Over time, breast sensation may return.

Results

Your reconstructed breast will look different immediately after surgery, but the final shape develops gradually over several months. Swelling subsides, the tissues soften, and the breast settles into a more natural position. Most patients see their final results within six to 12 months. Breast reconstruction cannot perfectly replace your original breasts, but it can create a natural-looking shape. Most importantly, the reconstructed breast is free of disease and helps restore your body’s contour.

The final results of breast reconstruction following mastectomy can help lessen the physical and emotional impact of mastectomy. Scar lines will improve, although they’ll never disappear completely. There are trade-offs, but most women feel these are small compared to the large improvement in their quality of life and the ability to look and feel whole again.

Long-Term Outlook

Reconstruction results are long-lasting, though your breasts will continue to change naturally over time, just as they would without reconstruction. Weight changes, aging, and gravity all affect reconstructed breasts. Some patients may benefit from revision or touch-up procedures years later to maintain their results.

Nipple Reconstruction

Nipple reconstruction can be performed once your breast mound has healed and settled into its final position, typically three to four months after your initial procedure. The nipple is created using small flaps of tissue from the reconstructed breast itself. This outpatient procedure is usually performed under local anesthesia.

Areola Tattooing

Medical tattooing can recreate the appearance of the areola with realistic color and shading. Tattooing is typically performed after nipple reconstruction and can dramatically enhance the natural appearance of your reconstructed breast. Some patients choose tattooing alone, without nipple reconstruction, and achieve beautiful results.

Symmetry Procedures

If only one breast was reconstructed, you may want a procedure on the opposite breast to achieve better symmetry. This might include a breast lift, breast reduction or breast augmentation, depending on your goals. The Women’s Health and Cancer Rights Act requires insurance coverage for surgery on the opposite breast when performed to create a symmetrical appearance. Unfortunately, many insurance companies are starting to deny this based on the use of artificial intelligence (AI) and considering words like ‘symmetry’ to be cosmetic. This is an evolving situation.

Fat Grafting

Fat transfer can improve breast contour, soften the transition between the implant and chest wall, and fill in areas where the reconstruction may appear uneven. Fat is harvested from another area of your body through liposuction, processed, and carefully injected into the breast. This technique can be particularly helpful for patients with thin skin coverage or visible rippling.

Scar Treatment

After your reconstruction, treatments at the Fox Valley Plastic Surgery Medispa can help minimize scarring and improve overall skin quality. Laser treatments and specialized skincare products can make a noticeable difference in how your scars mature over time.

Aesthetic Flat

There is no absolute need for a woman to have breasts nor total symmetry. Some patients choose to go to what is known as ‘aesthetic flat,’ where they don’t have to worry about the aspects of reconstruction nor the surgeries it involves. Whether or not to preserve nipple/areola will be discussed, which is an operation we are willing to perform for new patients and those who have decided they are done with their implants, especially if they are having discomfort after their reconstruction. Unfortunately, in many of the situations, this is in our radiated patient group. The wound complications are higher after this operation but most feel that it is worth it.