Breast reconstruction with implants using acellular dermal matrix
The acellular dermis technique takes advantage of the entire skin envelope available at the time of the mastectomy [127-129]. This technique creates a hammock under the mastectomy skin envelope to hold the expander or implant in place. The hammock is made from donated tissues (called "acellular dermal matrix") alone or in combination with your chest muscle. Similar techniques have been used for other reconstructive procedures in the body.
The acellular dermis procedure is less invasive and the length of the surgery is shorter than some other techniques. It also allows a larger breast mound to be created at the time of the mastectomy. This decreases the number of office visits needed to reach the desired implant volume. And, the expander can be replaced with the final implant sooner than with other tissue expanding techniques. Under ideal conditions, an expander is not needed and the final implant can be placed into the created hammock at the time of the mastectomy with no further surgery required.
Not all women can have the acellular dermal matrix technique (depending on the quality of the mastectomy skin envelope). Talk with your plastic surgeon to find out if this procedure may be right for you.
Nipple reconstruction with implant procedures
Reconstruction of the nipple is done when the permanent implant is inserted in the operating room or as a third step in the office. Learn more about nipple and areola reconstruction.
Saline versus silicone implants
There are pros and cons to each type of implant. These are described in the table below. However, you should discuss your options with a plastic surgeon to choose the type that is best for you.
| Saline implants | Silicone implants | |
| Feels like a natural breast | Less able to mimic the feel of a natural breast | Better able to mimic the feel of a natural breast |
| Flexibility in expander or implant size | Size of the expander may be increased or decreased after the initial surgery
| Size of the implant cannot be changed without surgery to replace the implant |
| Risk of rupture | Equal chance of rupture | Equal chance of rupture |
| What happens if rupture occurs? | The saline is absorbed harmlessly into nearby tissues. The reconstructed breast appears deflated, so you know right away the implant has ruptured. | Some silicone gel might leak into the soft tissue pocket around the implant and rest there. Since the silicone is not absorbed, the overall breast volume stays the same. So, a rupture in a silicone implant may take longer to be detected than a rupture in a saline implant. |
| Side effects that may occur with the implant procedure |
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| Replacement | Typically lasts at least 10 years, but will likely need to be replaced during lifetime (replacement requires surgery) | Typically lasts at least 10 years, but will likely need to be replaced during lifetime (replacement requires surgery) |
| Adapted from FDA and American Society for Aesthetic Plastic Surgery and American Society of Plastic Surgeons materials [121,130]. | ||
