Dr. Chang uses his advanced training to help you safely achieve a beautiful and confident post-mastectomy appearance.

Implant-based breast reconstruction can be a transformative option for patients undergoing mastectomy who wish to restore the natural appearance and volume of their breasts. Breast implants are selected based on your individual anatomy and aesthetic ideals to replace the breast volume removed during your mastectomy. This is one of the most common types of breast reconstruction and is associated with very high levels of patient satisfaction.

Overview & Why Choose Dr. Chang

Implant-Based Breast Reconstruction

  • Patients Undergoing Mastectomy – Implant-based reconstruction is a good option for the majority of patients undergoing mastectomy. Patients can choose, to an extent, if they would like to remain roughly the same size, smaller than, or larger than their pre-operative breast size. There is a limit on the size of breast implants, so for patients with very large breasts who wish to stay their same size, autologous reconstruction with flaps is a better option.

  • Patients Who Do Not Need Radiation Therapy – Radiation therapy, before or after implant-based breast reconstruction, significantly increases the risks of reconstruction failure. While radiation therapy is not a complete contraindication to implant-based breast reconstruction, Dr. Chang will discuss you the risks and the alternative of autologous breast reconstruction.

  • Healthy Patients – Healthy, non-smoking patients without major medical conditions that would make surgery or general anesthesia unsafe are candidates for this surgery. Conditions that pre-dispose to increased complications such as diabetes, vascular disease, autoimmune conditions, immunodeficiencies, etc. are still candidates for surgery but require additional pre-operative counseling and optimization.

  • Realistic Expectations – Dr. Chang views surgery as a partnership between the patient and him. It is important trust and confidence go both ways. Together, we will discuss your goals and if we can reasonably achieve those goals based on your anatomy.


Who Is a Candidate?

  • Medical Evaluation – Dr. Chang will review your medical conditions, medications, prior surgeries, and personal and family history of breast diseases, masses, and cancers. Some patients may be referred to their primary care doctor or a specialist to ensure you are medically optimized for a safe surgery under general anesthesia and post-operative recovery.

  • Breast Examination – Dr. Chang will perform a physical examination of your breasts. This will include measurements of the size, location, and symmetry of the breasts and nipple-areolar complexes. Dr. Chang will assess the skin quality, the weight/volume of excess breast tissue relative to your desired size, and the positions of the nipple areolar complexes to help determine the best surgical approach. This examination also facilitates proper implant selection.

  • Clinical Photographs – Clinical photographs from multiple views will be taken of your breasts. These photos are used to plan for your individualized surgery and compare before and after surgery. No photographs will be published online without your written consent.



Pre-Operative

Vertical

This approach removes an ellipse of skin around and including the nipple-areola complex in a vertical pattern.

Transverse

This approach removes an ellipse of skin around and including the nipple-areola complex in a transverse pattern.


Wise-Pattern

This approach removes skin around and including the nipple-areola complex in both the vertical and transverse dimensions. This approach is used for patients with significant excess breast skin or in patients who want to have smaller reconstructed breasts.


Skin-Sparing Mastectomy

 Inframammary Fold
This approach uses a transverse incision, hidden in your inframammary fold.

 Radial
This approach uses an incision along part of the circumference of the areola and then extending radially outward in one direction.

 Wise-Pattern
This approach uses an incision around the areola, within the inframammary fold, and vertically between the two. This approach is used only in select cases to reposition the nipple-areola complex at the same time as the mastectomy.


Nipple-Sparing Mastectomy

Overview:

 Dr. Chang and your breast surgeon will choose the incision approach (which determines your final scar) by balancing the need for easy and complete cancer removal and the desire to minimize the cosmetic burden. For patients with excess skin who are interested in a more contoured breast following reconstruction, Dr. Chang may recommend more extensive incisions to achieve that aesthetic goal.

Incisions

How Is Implant-Based Breast Reconstruction Performed?

Pre Pectoral

In the majority of cases, the implant is placed directly underneath the mastectomy flaps and on top of the pectoralis major muscle. The benefit is no risk of animation deformity and lessened morbidity from decreased surgical disruption of the chest. Patients must have well-perfused mastectomy flaps so that the incisions can heal without implant exposure or infection. While all patients are eligible for this pocket, thinner patients are at higher risk for implant edge rippling and visibility.

Sub-Muscular

With this pocket, the implant is placed underneath the chest wall muscles: pectoralis major and serratus anterior. The muscles are lifted off the underlying rib cage to add an additional layer of protection over the implant. The tradeoff is the risk of animation deformity and the downside of more surgical interruption of the chest wall.


Implant Pocket

Acellular dermal matrices (ADMs) are tissue scaffolds made from cadaveric human, cow, pig, and sheep proteins that are now widely used with implant-based breast reconstruction. The implants and tissue expanders are wrapped in the ADM, and the ADM is used to help control the position of the implant in the mastectomy pocket. Because the ADM incorporates into normal body tissue, it adds an additional layer of tissue and protection between the skin and implant.

Acellular Dermal Matrix

  • Dressings and Incision Care – Your incisions will be dressed with surgical bandage strips and/or surgical skin glue. You will be wearing a comfortable surgical bra stuffed with gauze pads. The bra should be snug but not overly tight. You should try to wear the surgical bra as much as possible but may remove to shower and to wash the bra. You may shower the day after surgery but cannot bathe or swim until instructed to do so.

  • Pain Management and Medications – Local anesthetic (numbing medication) will be injected at your surgical sites to minimize your immediate post-operative pain. You should take acetaminophen and an NSAID around-the-clock, according to instruction, for the first 72 hours and then as-needed thereafter. You can purchase these over-the-counter. You will be given a small number of low-dose narcotic pain medications for breakthrough pain only for the first 72 hours.

  • Recovery Period – Most patients are admitted for 1-2 days after surgery for pain control. While in the hospital, you are expected to ambulate the same day of surgery. Depending on your occupation, you may return to work 2-4 weeks after surgery. You may resume light cardio exercises at 2 weeks after surgery. You should not lift anything heavier than 5 pounds or extend your arms extensively over your head for the first 2-4 weeks after surgery. You may resume all physical activities at 4-6 weeks after surgery. You should expect some drainage from the incisions and mild bruising around the incisions. You will be swollen, and it can take up to 3-6 months for the swelling to reside. Your incisions will take 2-4 weeks to completely heal, but the final scar will take 6-12 months to mature. Scar care will be discussed at your 1 month post-operative appointment.

  • Follow-Up Visits – If you have any urgent concerns, you may call the office at any time. Otherwise, patients with direct-to-implant reconstruction should expect follow-up visits at 1 week, 1 month, 3 months, 6 months, and 1 year. Patients with staged tissue expander reconstruction should expect follow-up visits at 1 week, at the start of tissue expansion at 2 or 4 weeks, and then every 1-2 weeks after that until the tissue expansion process is complete.





Post-Operative

  • Unmet Expectations – Despite thorough pre-operative planning and discussions, you still may not be fully happy with your aesthetic results

  • Asymmetry – No one’s breasts are perfectly symmetric. While the goal is near-perfect symmetry, there may be some asymmetries in breast size or position, nipple-areola complex size or position, and scars. 

  • Implant Exposure – If the incisions break down or you experience mastectomy flap necrosis, the underlying implants may become exposed. This requires removal of the implants and a delayed reconstruction.

  • Implant Rupture – Both saline and silicone implants can rupture. For saline implants, you will notice a relatively abrupt decrease in your breast size, and your body will absorb the saline naturally. For silicone implants, the silicone generally stays within the capsule of the implant but sometimes can spread outside.

  • Implant Malposition – The breast implants may move into an incorrect position, typically falling too low on the chest from gravity or too close to the middle or too far out on the sides.

  • Capsular Contracture – A capsule of your body’s tissue forms around the outside of the implant. Occasionally, this capsule can become very thickened and can be palpable, distort the implant, or cause pain.

  • Poor Scarring – Everyone scars differently. The final scar takes 6-12 months to mature. In rare cases, hypertrophic scars or keloids may form and may require secondary revision.

  • Infection – Infections are managed with antibiotics. In severe cases, the implants may need to be exchanged or removed completely to be replaced at a later time in a delayed fashion.

  • Bleeding – Significant bleeding after surgery may require an urgent return to the operating room. Smaller collections of blood may be treated conservatively or managed with a small procedure in the office or the operative room.

  • Changes in Sensation – Permanent changes in breast and nipple-areola complex sensation are expected because all the major sensory nerves are cut during a mastectomy. Some sensation often returns between 6-12 months, but you should expect your breasts to feel differently than before surgery.



Complications of Implant-Based Breast Reconstruction

Trust in Expert Care for Beautiful Results – Contact Us to Learn More!

Request a consultation