Dr. D. NARDELLA
Plastic and cosmetic surgery
                       

Breast reconstruction with implants :

This remains the most common reconstruction technique in the world. It has many advantages (short-term intervention, pain localized only in the breast) but also several disadvantages (presence of a foreign body, need to change the implants after 8-10 years, difficulty in mobilizing the arm).

The implant is inserted through the mastectomy scar (breast removal) or via the areolar route (subcutaneous mastectomy with preservation of the areola).

The use of a temporary implant called an "expander" or "expander" is often recommended. It allows the final volume of the reconstructed breast to be chosen by injecting physiological fluid (water) through the skin. It gives more precise results but requires a second operation to place the definitive implant (3 to 6 months after the first surgery).

Breast reconstruction for patients with the BRCA gene (hereditary breast cancer):

Certainly this reconstruction is favored by the immediate placement of the implant during the removal of the breast. The implant is passed through the areolar route with a limited scar. The aesthetic results as well as the complications are strongly associated with the consumption of tobacco. In this case the risk of areolar necrosis (loss of vitality of the areola) is much greater than in non-smokers.

Complications following implant placement:

In the short term, the risks of infections, hematomas and lymph production are part of what we call short-term complications.

Hematoma can form after breast implant surgery. Its frequency is around 5%. Evacuation to the operating room is necessary if the hematoma is large.

Infection is uncommon, pre- and post-operative hygiene can reduce its formation. Targeted antibiotic therapy and taking anti-inflammatories can resolve this type of problem. In the event of an abscess, drainage in the operating room and removal of the implant may be necessary.

For long-term complications, the shell, asymmetry and dislocation of the implant must certainly be considered.

The implant is identified as a foreign body by our body. The healing around the implant forms a kind of membrane called the "periprosthetic shell". This shell forms after a few months and is thin. After a few years the shell increases in thickness, making the breast firmer and sometimes uncomfortable.

Asymmetry may be present initially because the breasts are of different volumes, especially if only one side is operated on. If the problem persists, a symmetry procedure resolves the complication.

When we talk about dislocation, it is a displacement of the implant from its initial position. Correction may be necessary in the event of a significant dislocation.