Implant-based breast reconstruction following mastectomy

Post-mastectomy breast reconstruction with prostheses can be performed immediately at the time of mastectomy or delayed for several months or years. It falls into three main categories namely implant-only, expander-implant and expandable implant reconstruction. Sometimes it is combined with the latissimus dorsi myocutaneous flap. Logistically prosthetic reconstruction can be single-stage (with implant-only or expandable implants) or two-stage (traditional expander-implant technique). Over the last decade a wide variety of prostheses has become available which materially vary in shape, surface and consistency. Prosthetic breast reconstruction provides satisfactory results in properly selected patients and has the advantages of simplicity, shorter operating time, hospital stay and recuperation. Additionally there are no extra scars or distant donor site morbidity. It is, however, more prone to additional unplanned revisional surgical procedures than autogenous tissue reconstruction. In general two-stage reconstruction gives more predictable results as it gives the surgeon the opportunity to adjust the reconstruction at the planned 2nd stage, while in practice, single stage reconstruction may be more prone to unplanned revisional surgery. The best results are obtained in patients with small minimally ptotic breasts while those with larger and/or more ptotic breasts often require a contralateral balancing procedure to achieve symmetry. This paper outlines the surgical options and the prosthetic range available at present.