Implant-based breast reconstruction following conservative mastectomy: one-stage vs. two-stage approach

Abstract

Conservative mastectomy with preservation of the nipple areolar complex is now considered a safe and effective technique in properly selected patients. Good candidates for this procedure include women with small to moderate breast volume having therapeutic or prophylactic mastectomy. Both autologous and prosthetic options are available; however prosthetic techniques are performed more frequently. Prosthetic approaches include immediate 1-stage (direct to implant) or 2-atge (tissue expander/implant) techniques. Delayed prosthetic reconstruction is also possible with conservative mastectomy. This manuscript will review the 1-stage and 2-stage methods with an emphasis on indication, surgical techniques, and outcomes.

Keywords: Breast reconstruction; breast implants; conservative mastectomy; nipple sparing mastectomy; tissue expanders.

Figure 1

Preoperative photograph of a patient with left breast cancer scheduled for unilateral conservative mastectomy.

Figure 2

Intraoperative photograph of the lateral and periareolar incision with a 300 cc permanent implant and acellular dermal matrix.

Figure 3

Preoperative photograph following permanent implant placement. The plan is for right augmentation with a 100 cc device and exchange of the left implant for a 350 cc device.

Figure 4

Postoperative photograph demonstrating excellent volume and contour symmetry at 1 year follow-up.

Figure 5

Preoperative photograph of a patient scheduled for bilateral risk reduction conservative mastectomy.

Figure 6

Early postoperative photograph following bilateral breast reconstruction with tissue expanders.

Figure 7

Preoperative photograph with fully inflated tissue expanders.

Figure 8

Postoperative photograph with bilateral 400 cc silicone gel implants demonstrating excellent volume and contour symmetry.

Figure 9

Right lateral view demonstrating excellent contour.

Figure 10

Left lateral view demonstrating excellent contour.

Figure 11

Preoperative photograph of a woman following right conservative mastectomy scheduled for delayed 2-stage prosthetic reconstruction.

Figure 12

The lateral and infra-areolar incisions are opened and the tissue expander and acellular dermal matrix are placed.

Figure 13

Preoperative photograph demonstrating an over inflated tissue expander scheduled for exchange and contralateral augmentation for symmetry.

Figure 14

Postoperative photograph demonstrating excellent volume and contour symmetry at 6 months follow-up.