A Personal Account of Implant Reconstruction

I would like to introduce Carol who is a 56 year old lady who was diagnosed in February 2015 after finding a small lump under her nipple on her right breast. Subsequently another lump was found near to her chest wall and multiple early stage cancer cells. Carol was diagnosed with Triple Negative Breast Cancer, Grade 3. She was originally given the options of a Wide Local Excision (lumpectomy), but the discovery of more cancer in the breast changed this to a mastectomy. Carol chose to have the affected breast reconstructed with an implant.

This is Carol’s story:

Breast reconstruction using an implant, is when an implant is put in under your chest muscle to form a breast. Depending on personal needs, this may be one stage, where a permanent implant is put in, or in two stages, where a temporary implant (expander) is put in and replaced when the breast is the right shape. The expander implant has a port (a metal or plastic plug, valve, or coil) that allows the breast consultant surgeon to add increasing amounts of liquid (a salt water solution) over time (normally between 2 to 6 months) until the skin gradually is stretched enough to accommodate the implant. If you have an expander implant, and there is a possibility you will have radiotherapy, you will need an expander with a plastic port, as a metal port interacts with the radiation right around the metal and can cause skin damage. At the time of my surgery it was not known if I would need radiotherapy as one of my tumours was very close to my chest wall so an expander was put in just in case it needed to be whipped out.

In some cases, your plastic surgeon may also recommend using a surgical mesh or dermal matrix product that covers the implant and provides a structure for your skin to grow in and around. This supports the weight of the implant as well. This may allow more liquid to be added to the expander during surgery, which may lower the number of times more liquid has to be added later.

When I was advised to have a mastectomy, the options for reconstruction were described to me by my Breast Care Consultant who also performed the surgery. Sometimes it’s a different consultant that performs the surgery so you may have a more detailed discussion with another Consultant.

My options were immediate reconstruction, delayed reconstruction, no reconstruction. I chose immediate reconstruction because I wanted to wake up from my mastectomy with a breast. I was advised to have the two stage reconstruction (ie expander first and then implant later). Whether your operation is done in one or two stages will be discussed with you by your surgeon.

My decision to have an implant reconstruction was an easy one. I’d had abdominal surgery and so the alternative DIEP (using fat from my body) meant that I couldn’t have this procedure so I would have to have fat/skin taken from my back or thighs (LD or TUG reconstruction). I felt that my overall recovery from the mastectomy would be better for me with the implant reconstruction.

My consultant described the procedure, horizontal excision across my breast, removal of my breast tissue and replacement with an expander implant with a surgical mesh, meaning I could have more saline liquid inserted at the time of surgery. I would have a couple of drains inserted in my breast for waste fluid to drain from my breast. He also explained the risks, the main one being capsular contracture where the tissue around the breast hardens which may mean replacement of the implant. I was advised that sometimes implants may have to be replaced in the future and to be prepared for this. Scars from this operation vary from surgeon to surgeon so it’s important to ask where your scars will be and why.

Preparing for Surgery

I was advised that the surgery would take 2-3 hours, and I would return from theatre wearing a compression bra to support the new breast. It’s important to have easy clothing to put on during recovery, loose comfortable leggings and tops to step into or button through avoiding lifting of the arm. If you are planning to be mobile, then a bag that you can pop the drains into (they have two bottles at the end) and hook over your shoulder makes it much easier, as does a long shawl or wrap that you can put around you to hide the drains. Recovery would be a couple of weeks with physiotherapy to begin soon after the surgery. Pre-op tests were done the week prior to make sure I was fit for the procedure

Day of Surgery – March 2015

I was feeling quite excited to be finally getting my cancer removed and getting a new boob! I was visited by my surgeon who drew on my breast and anaesthetist who checked my medical history. Post surgery there was mild pain in my chest and I had difficulty moving my arm on the same side. This is all normal and additional pain relief soon sorted this out. I didn’t have a catheter as I was encouraged to be gently moving around to aid recovery with the nurses assistance. When getting out of bed, I needed to use my opposite arm and side of body. It was brilliant to look down at my chest and see it looking all intact.

Day 2

I felt much better and was visited by a physio. It’s really, really important to do the exercises even though it does hurt a bit to do them at first. If you stick at them you won’t believe how quickly you will return to full movement. Washing was a bit slow but in my compression bra I looked like me.

Day 3

I felt even better. I Increased the exercises and was encouraged to walk around before going home with drains, instruction on recording waste flow, surgical stockings and a post op recovery information sheet were given so that I knew what to do.

A few days later I had to return to hospital for drain removal and check on wound and dressing. The compression bra had to be worn for two-four weeks after surgery both day and night.

The first time I saw my new boob was after a few days when the drains were removed and dressing changed and I was delighted. Already I was feeling like me! After a few days of doing the physio exercises and once the drains were removed I felt free again.

I did not need to have my expander implant topped up, but if you do then you will be advised on when to return for this. You can get twinges of pain in your new breast and this is normal. Also when you lay down you can get little craters where the fluid is moving in the implant – spooky but completely normal.

Permanent implant – October 2015

Three months after I finished my chemotherapy and six months after my initial reconstruction, my implant was replaced with a permanent one. This is normally done as a day case and a much shorter recovery time and no drains. I did take a couple of weeks off work to recover from the anaesthetic and surgery and also was still recovering from the effects of chemotherapy.

Nipple Reconstruction – February/May 2016

In February 2016 I decided to have a nipple reconstruction done. I was toying around with whether I wanted to just leave the breast as is, so was glad that I waited to make my decision. The nipple reconstruction was done under local anaesthetic which I actually enjoyed as the theatre staff made me very comfortable and my breast care consultant chatted to me all the way through.

The procedure involved using surrounding skin on my reconstructed breast which is extracted and elevated to form and shape a living tissue projection that looks like a natural nipple. One of the things that is important about the success of this is a good blood supply in the reconstructed breast which is greatly helped by exercise.

The whole thing took about 1.5 hours and I went home straight after with a dressing. Really quick recovery and no post op issues. Have to take to take it easy for a couple of days but other than that very straightforward procedure.

In May 2016, allowing time for my nipple to fully heal, I had my areola tattooed. Again a local anaesthetic for the tattoo which took about 30 minutes to do, home same day and same recovery as a tattoo anywhere else on your body. It looks quite dark at first and then fades. I am really pleased with all of my breast reconstruction procedures and my boob just feels like it has always been there.

End Result

Compared to my left breast, my right reconstructed breast is perkier as it has been lifted by an implant, but in a bra and clothes you can’t tell the difference. I am considering having my left breast lifted but that will be in the future at some point.