8 Implant-based breast reconstruction: Exchange of tissue expander for permanent implant

10.1055/b-0037-143396

8 Implant-based breast reconstruction: Exchange of tissue expander for permanent implant

ARI S. HOSCHANDER, MICHAEL P. OGILVIE, AND JOHN OELTJEN

INDICATION

Permanent implant replacement after use of tissue expanders for immediate reconstruction

INTRODUCTION

There are many options available to the plastic surgeon and patient considering breast reconstruction after mastectomy. As expressed in the previous chapter, implant-based reconstruction is a viable option that has produced excellent results from both an aesthetic and a reconstructive standpoint. ¹ Although some surgeons prefer immediate reconstruction with permanent implants, the prevailing trend is to place temporary tissue expanders first, followed by expansion and then a second operation exchanging the tissue expander for a permanent implant. The choice of delayed versus immediate reconstruction is based on multiple factors and is not addressed in this chapter. Table 8.1 indicates special equipment needed.

Table 8.1 Special equipment
Antibiotic irrigation solution with Normal saline 500 mL Ancef, 1 g Gentamicin, 80 mg Bacitracin, 50,000 units Ancef 1–2 g IV and vancomycin 1 g IV given prior to incision Long-tip Bovie Lighted retractor Implant sizers Permanent breast implants^a Sterile antiseptic skin preparation
^a Multiple successive sizes should be selected based on the base width of the chest and beginning with the volume currently in the expander. Usually, a volume of 25% more than the current expansion will be needed.

PREOPERATIVE MARKINGS

Midline from sternal notch to umbilicus
Bilateral inframammary folds (IMFs)
Measure approximate base diameter for permanent implant size estimation (Figure 8.1)