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THE PROCEDURE

TYPES OF BREAST RECONSTRUCTION
Your breast reconstruction surgery can be achieved through a variety of different techniques. The appropriate reconstructive procedure for you will be determined based on your discussions with your surgeon, your body type, and prior therapy and/or surgical treatment 

IMPLANT RECONTRUCTIONS
EXPANDER/IMPLANTS
First, a temporary device known as a tissue expander is placed in the breast to create the soft pocket that will contain the permanent implant. Some surgeons may also use an acellular dermal matrix to assist with reconstruction. Once expansion is complete, the expander will be exchanged for the permanent implant during an outpatient procedure. In expander/implant reconstruction, patients can expect the following to occur with some exceptions:
Hospital stay(Mastectomy/Expander): 1-2days
Recovery Time(Mastectomy/Expander): 4-6weeks
Hospital stay(Implant exchange): Outpatient
Recovery Time(Implant Exchange) 1-2weeks

DIRECT TO IMPLANT
This approach allows for a breast implant to be placed immediately following mastectomy, foregoing the need for a tissue expander, some patients may still require a secondary procedure. In direct-to-implant reconstructions, patients can expect the following to occur with some exceptions:
Hospital stay: 1-2days
Recovery Time: 4-6weeks

FLAP RECONSTRUCTIONS
DONOR SITE: ABDOMEN
TRAM flap: The most common method of tissue reconstruction is pedicled transverse rectus abdominus myocutaneous (TRAM) flap. In this approach, abdominal muscles, tissue, skin and fat are used to create breast shape. The patient will have the benefit of a flatter looking abdomen. The scar on the abdomen is low and extends from hip to hip. In TRAM flap reconstructions, patients can expect the following to occur with some exceptions:
Hospital Stay: 2-5days
Recovery Time: Several weeks to several months
DONOR SITE: ABDOMEN

Abdominal free flap: These microsurgical (DIEP SIEP) procedures may or may not use the actual abdominal muscle, so they may allow for results with fewer donor site complications, however they are lengthier procedures and have the potential for other complications. These procedures should only be performed by plastic surgeons who perform microsurgery regularly and institutions with experience in monitoring these flaps. In free flaps reconstructions, patients can expect the following to occur with some exceptions:
Hospital stay: 3-5days
Recovery Time: several weeks to several Months

DONOR SITE: BACK
LD FLAP: The latissimus dorsi (LD) flap is the most commonly combined with an implant. At the time of breast reconstruction, the muscle flap, with or without attached skin is removed from the back and implanted in the breast. This flap provides a source if soft tissue that can help create a more natural looking breast shape compared to an implant alone. The scare on the back can often be concealed under a bra strap . In LD flap reconstructions, patients can expect the following to occur with some exceptions:
Hospital Stay: 1-3days
Recovery Time: Several weeks 

DONOR SITE: BUTTOCK
GAP flap: The gluteal artery perforator (GAP) free flap uses skin and fat from the buttocks. This type of reconstruction is technically more difficult to perform than other procedures. Also, the tissue from the buttock is somewhat harder to shape into a breast. In GAP free flap reconstructions, patients can expect the following with some exceptions:
Hospital stay: 3-5days
Recovery time: Several weeks

DONOR SITE: THIGH
inner thigh free flap: this procedure uses skin, fat and muscle from the inner portion of the upper thigh to reconstruct the breast, the tissue is dissected from the inner thigh and transplanted to the chest it is reattached using microsurgery. The resulting thigh scar is generally well hidden. In thigh free flap reconstructions, patients can expect the following to occur with some exceptions:
Hospital stay: 3- 5days
Recovery Time: Several weeks

IMPLANT CHOICES
Your plastic surgeon will talk to you about your breast reconstruction options. There are a number of different options for implants that may be used during your breast reconstruction.

SALINE IMPLANTS are filled with sterile salt water. They can be filled with varying amounts of saline which can affect the shape, firmness and feel of the breast. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body. Saline implant can feel or look wrinklier in thin patients.

SILICONE IMPLANTS: are filled with an elastic gel. The gel feels and moves much like natural breast tissue. If the implants leak, the gel may remain within the implant shell, or may escape into the breast implant pocket. A leaking implant filled with silicone gel may not collapse. If you choose these implants, you may need to visit your plastic surgeon regularly to make sure the implants are functioning properly. An ultrasound or MRI screening can assess the condition of the breast implants.
 
SHAPE
Form stable implants: mimic the natural shape of the breast and are shaped like a tear drop. They are thicker at the bottom and tapered towards the top.
They are usually filled with a cohesive gel. If they rotate, they may lead to a strange appearance. It is also usually necessary to have a longer incision with these implants

Round Implants have a tendency to make reconstructed breasts appear fuller than form stable implants. They also often will make the breast project out further away from the body. New high-profile options can lead to even more projection, if that is a concern for you. Because they are the same shape all over, there is less concern about them rotating out of place 

Texture
Textured breast implants allow the scare tissue to stick to the implant, making them less likely to move around inside of the breast and get repositioned.

Smooth Breast implants move around freely inside of the breast, which may give more natural movement. These implants also have increased risk of rippling.
Your plastic surgeon will take into account your wishes and concerns and will choose the right breast reconstruction option for you.

Implants manufacturers occasionally introduce new styles and types of implants, so there may be additional options available. Whether you choose saline or silicone implants, it is important for you to monitor your breast implants and follow up with your plastic surgeon for appropriate checkups. 

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