Implant Based Breast Reconstruction
by F. Ryan Wermeling, MD
Reconstruction with implants is the most common form of breast reconstruction used in the United States. At the time of the mastectomy a tissue expander, a temporary saline device, is placed under the skin of the breast.
I place the tissue expanders above the muscle, eliminating the need to lift the muscle off the chest which reduces pain after surgery. An important component to this new
pre-pectoral technique is the use of a collagen mesh that gives the implant more support.
The tissue expander is slowly inflated during visits to my office. You get to choose the final size of your reconstruction! When you are happy with your size, a second out-patient surgery is done to replace the tissue expander with your permanent implant. In most cases, the tissue expander creates a shape that is very similar, but not exactly, like a breast. This final surgery can help to refine the shape of the breast when the permanent implant in placed. I also frequently use fat grafting to soften the edges of the implant and refine the shape even further.
Recreating the nipple is the final step on your reconstructive journey. It is usually performed as a separate procedure after healing of your implant or flap and can be done in our office operating room without the need for general anesthesia. The procedure involves lifting a small amount of skin and turning it onto itself to create projection in the new nipple. Tattooing follows after a few weeks of healing. I work with a fantastic team that can create photo-realistic 3D nipple tattoos that are truly amazing.