Breast Reconstruction in Portland & Lake Oswego

Implant Reconstruction:

Tissue Expanders

During mastectomy, or a later date, tissue expanders can be placed above the muscle (prepectoral) or under the muscle (subpectoral). The prepectoral placement may decrease animation movement of the tissue expander when the pectoralis muscle is flexed, so this may look like a more natural reconstruction. The tissue expander is a temporary implant that contains a port within its shell. This port allows for adding more saline once the mastectomy incision has healed to fill the tissue expander. This process is known as expansion. Expansions start after surgery and occur every one to two weeks until you have reached your goal.

During a quick, in-office procedure, Dr. Burgess or her staff will use a very fine needle to place about 50mL of saline into the port of your tissue expander, through a numb area on your chest. The area may feel tight and uncomfortable that evening. Each patient has their own expansion schedule that can work around chemotherapy appointments, and their personal life. The number of required expansions is very patient-specific. Your final expanded volume depends on your individual goals and your anatomy. Once you have reached a volume that you and Dr. Burgess feel is acceptable, you will undergo a surgery to remove the expander and replace it with a silicone or saline implant.

Acellular Dermal Matrix (ADMs)

After mastectomy, the remaining tissue over the chest wall may be thin. An Acellular Dermal Matrix (ADM) is often a human cadaveric or porcine product that’s utilized at the time of tissue expander placement. The natural anatomy of the pectoralis muscle may not be adequate coverage for the implant. In this case, an ADM may be employed to provide lower pole for better support and coverage if partially under the muscle. The ADM is sewn into the pectoralis muscle, allowing for greater support in the lower breast pole, while supporting the tissue expander and eventually, the implant. It can provide a natural shape or “hang” to the breast. ADMs also support cellular growth and healing, while providing stabilization of the implant. It is possible that the expander or implant could be placed on top of the muscle. However, it would typically be wrapped in a large piece of ADM.

Resorbable Surgical Scaffolding Or Mesh (Internal Bra)

As an alternative to an ADM, an absorbable mesh can be used almost like an internal bra can offer crucial support for patients undergoing breast reconstruction, providing additional lift, shape, and long-term structural integrity. By using bioresorbable mesh materials like DuraSorb or GalaFLEX, the internal bra acts as an internal scaffold that gradually dissolves, allowing the body’s natural tissue to take over the role of support.

• DuraSorb: This bioresorbable, sterile monofilament mesh dissolves more quickly, offering initial support while enabling the formation of natural tissue in its place. Although FDA-approved for soft tissue support in reconstructive and cosmetic surgeries, its use in breast reconstruction is considered off-label.
• GalaFLEX: This bioresorbable, sterile monofilament knitted mesh dissolves more slowly, providing extended support as it integrates with the body’s tissue over time. It is FDA-approved for soft tissue reinforcement in plastic and reconstructive surgery, though its use in breast reconstruction is considered off-label.

These materials can be particularly beneficial for patients with thin tissue, those undergoing revision procedures, or those seeking added lift or support in their reconstruction while maintaining natural movement.

Direct To Implant

Direct-to-implant reconstruction surgeries are performed at the time of mastectomy. They require the general surgeon and the plastic surgeon working in sync for part of the same procedure. Patients who have sufficient breast skin remaining after mastectomy may be well suited for direct-to-implant breast reconstruction. While the direct-to-implant method avoids use of tissue expanders, secondary procedures may be preferred to improve symmetry or breast size. Unless the initial mastectomy was done using a nipple-sparing approach, most women proceed with reconstruction of the nipple and areola.