Breast implants used to enlarge women’s breasts are sometimes placed under the muscle and sometimes over the muscle. When placed over the muscle, breast tissue acts as a cushion between the implant and the breast skin.
After mastectomy, however, which removes a woman’s breast tissue, reconstruction with implants traditionally involves placement of the implant under the pectoral muscle, so that the muscle provides a protective layer between the implant and the breast skin.
This involves placing a temporary implant called a “tissue expander” into a space that is created under the muscle. Over several weeks, as saline is gradually added to the expander, the pectoral muscle and breast skin slowly expand until a sufficient pocket is created to hold the breast implant. During a short surgery—about an hour or so for each breast—the expander is removed and a breast implant is put in its place. Although it usually works just fine, the expansion process is tedious, slow and can be uncomfortable.
Now, however, more surgeons are foregoing the under-the-muscle procedure, and instead performing breast reconstruction by placing the breast implant directly over the muscle. This shortened direct-to-implant technique is made possible by creating a sling of acellular dermal matrix (ADM), a sterile tissue substitute, that holds the implant in position, completing in a single procedure what expansion achieves over several weeks.
The direct-to-implant procedure has several advantages.
For some women, especially those who may have radiated or thin skin, or are prone to infection, gradual tissue expansion may prove to be a wiser process.
Most surgeons still prefer the tried-and-true expansion process, so it may be difficult to find someone who offers this streamlined method of implant reconstruction. Be sure to choose a plastic surgeon who is well experienced with the over-the-muscle procedure.
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