Two Stage Implant Reconstruction

An adequate amount of chest skin is required for reconstruction of your breast following its removal (mastectomy). When there is not enough skin to reconstruct the breast, a two-stage reconstruction is required.

A ballon-like device (tissue-expander) is placed below the pec muscle and chest skin. This device is gradually inflated to expand the tissues to accommodate a full-sized implant. At the second surgery, the tissue-expander is exchanged for a softer permanent implant.

Therefore, two surgeries are required in addition to the mastectomy surgery before your reconstruction is complete. On occasion, in specific cases, Dr. Yau will also perform the initial steps of the two-stage reconstruction on the same day as the mastectomy.

Two-Stage Implant Reconstruction Procedure

The steps below outline the surgical procedure in detail. Surgery for the first stage is typically 1.5 hours for reconstruction of one breast and 3 hours for reconstruction of both breasts. Surgery for the second stage is typically 1 hour for one breast and 2 hours for both breasts.

Step 1: During the first surgery, a temporary tissue-expander is placed almost completely underneath the pectorals major muscle.

Step 2: The tissue expander is sequentially inflated with saline at follow-up visits with Dr. Yau. This stretches out the skin until the pocket is of the appropriate size for placement of the final implant. Expansion typically occurs every 2-3 weeks over several months.

Step 3: Once the tissue expander is fully expanded, the second surgical stage is planned. During this procedure, the tissue expander is exchanged for the softer, permanent implant.

Recovery after Two-Stage Implant Reconstruction

Following the first stage of surgery, the patient is admitted to the hospital overnight. The second stage of surgery is a day surgery only not requiring an overnight stay. Drainage tubes will be inserted into the breast and will be removed by Dr. Yau when the drainage has decreased sufficiently, usually by post-operative day 10-14. There will be a transverse scar across the breast. Patients typically resume regular activities in 10 days and full strenuous exercise in 4 weeks. Nipple reconstruction typically occurs 3 months after surgery.

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