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Reconstruction with Expander and Implant

The easiest way of breast reconstruction is by inserting an implant. Breast implants are usually filled with silicone gel. Technical development of these implants has led to the contained gel rarely leaking out of them. It has been proved in major global case-studies that there is no direct connection between implants and other conditions such as migraine or neurological disorders. Implants used by us are checked and permitted throughout the whole of Europe.
However, reconstruction with implants is not always the best option after removing the breast, because there often is not enough skin left. Often the skin has to be stretched by a so-called expander (balloon process) to be able to insert a suitable implant in another operation. When an expander is used to stretch the skin it has to be filled from the outside with saline solution. This happens once a week after the skin has recovered until the degree of stretching necessary has been reached. This process usually is not painful, though it might cause a feeling of tension.
In some cases it is helpful to support the implant with so called ADM, acellular dermal matrix. This helps to keep the implant in place. However, ADMs cause more complications concerning wound healing.
If radiation treatment is planned or was performed, reconstruction with implants should be abstained from because radiation leads to a higher rate of fibrosis.

Operation

The skin incisions are already made by the previous removal of the breast, so that new scars are mostly unnecessary. If possible, the implant is placed behind the breast muscle to achieve enough coverage with soft tissue. In the first days following the operation the wound secretion is diverted by a drainage tube.

Risks and possible complications

Capsular contracture is the most common problem following breast reconstruction with an implant, as this is a foreign body and is covered with a layer of connective tissue from the body. There are no problems as long as this covering cannot be felt. Nevertheless, this coat can get so hard that it squashes the implant leading to unsightly deformations and also pain. This is then called capsular fibrosis or contracture. In this case the implant should be removed and alternative actions should be taken. The frequency of such a fibrosis is 40 percent, around 80% of them occurring within the first two years after inserting the implant for reconstructive purposes.
If radiation treatment is planned, reconstruction with implants should be abstained from because radiation leads to a higher rate of fibrosis.
Swellings, infections or a lasting feeling of tension of the stretched skin are further risks, especially when an acellullar dermal matrix (ADM) is used for recontruction.

Pre- and Follow-up Treatment

Special treatment prior to the operation is not necessary. If the removal and the reconstruction of the breast are performed in two operations, a pause of 6 months should be between them in order to allow the breast to heal adequately.
When an expander is used to stretch the skin it has to be filled from the outside with saline solution. This happens once a week after the skin has recovered until the degree of stretching necessary has been reached. This process usually is not painful, though it might cause a feeling of tension.
After the operation we suggest wearing a support bra for 3 months to avoid stretching the scars and to allow scars to heal nicely.