Implant-Based Breast Reconstruction
Lower Manhattan, New York, NY
Implant-based reconstruction offers patients a relatively straightforward path to restored breast contour. An implant — either placed immediately at the time of mastectomy, or staged through an initial tissue expander — provides immediate breast volume and allows you to focus on cancer treatment with contour already restored.
Implant reconstruction is not a "lesser" choice compared to autologous (tissue-based) reconstruction. It is a legitimate, widely chosen option with distinct advantages: quicker recovery between surgical stages, the ability to achieve the exact size you desire, and a streamlined timeline that fits well with concurrent cancer treatment. The trade-off is that implants require lifelong surveillance and may need future replacement; they can be affected by radiation therapy; and a condition called capsular contracture (firmness of scar tissue around the implant) can occasionally develop.
Dr. Janssen performs implant-based reconstruction at Lenox Hill Hospital, coordinating closely with your breast surgery and medical oncology teams to ensure your reconstruction supports rather than interferes with cancer care. Your specific approach — one-stage immediate implant placement or two-stage tissue expander-to-implant — will be determined based on your mastectomy type, anticipated radiation, tissue quality, and personal preferences.
An implant is placed directly during your mastectomy surgery. You wake with breast contour restored. Appropriate for select patients with good skin quality and specific mastectomy types. Also known as "Direct-to-Implant" reconstruction.
A temporary tissue expander is placed at mastectomy. Over 8-12 weeks, gradual weekly expansions stretch your skin. A second brief surgery exchanges the expander for a permanent implant.
Silicone gel or saline-filled implants; smooth or textured surfaces; various projections and profiles. Dr. Janssen selects the most appropriate implant based on your anatomy and goals.
Individual surgeries have quick recovery (1-2 weeks). Total timeline from mastectomy to final reconstruction is 3-4 months for two-stage, immediate for one-stage. Allows focus on cancer treatment without prolonged post-surgical recovery.
The most commonly performed implant-based reconstruction uses a two-stage approach: temporary tissue expander placement followed by permanent implant exchange. This method is advantageous because it allows your tissues time to heal between surgical interventions and gives you time to focus on cancer treatment without the demands of fresh surgical recovery.
The First Stage: Tissue Expander Placement
At the time of mastectomy, a tissue expander — a silicone device with a small metal filling port — is placed beneath the pectoralis major muscle. The mastectomy incision is closed over the expander. A drain is left in place temporarily to prevent fluid accumulation. Over the first 1-2 weeks, your tissues begin healing around the expander.
The Expansion Process
Beginning 1-2 weeks after surgery, you return to the clinic weekly (or every other week) for expansion. Using a magnet to locate the metal port through your skin, Dr. Janssen injects saline solution through a small needle, gradually inflating the expander. The process is typically painless or causes only mild discomfort. You can return to work or normal activities immediately after each expansion appointment.
The expansion continues over 8-12 weeks until the skin is stretched slightly larger than your desired breast size. This extra volume allows for natural breast "droop" and prevents the expander from being felt through the skin. Once expansion is complete, the expander remains in place for several weeks to allow tissues to stabilize and the skin to settle.
The Second Stage: Implant Exchange
When ready, you return for a brief surgical procedure (typically outpatient) to remove the tissue expander and place a permanent silicone or saline implant. The surgery uses the existing mastectomy scar; Dr. Janssen makes an incision along this scar, removes the expander, adjusts the scar capsule if needed, and positions the permanent implant. The incision is closed; drains are not always necessary. Recovery is quick — most patients return to work within one week.
Why Choose the Staged Approach?
This method allows your body to accommodate the new breast volume gradually, reducing post-operative discomfort. It provides time for your cancer treatment to proceed without the demands of fresh post-surgical recovery. And it allows Dr. Janssen to assess your healing between stages and make refinements to achieve optimal symmetry and proportion.
In selected cases, an implant can be placed directly at the time of mastectomy without the use of a tissue expander — what is termed "direct-to-implant" or one-stage reconstruction. This approach eliminates the need for weekly expansion appointments and accelerates the overall timeline.
One-stage reconstruction is appropriate for patients with good-quality mastectomy skin flaps, adequate soft tissue coverage, and specific mastectomy types (such as nipple-sparing mastectomy). It is not appropriate for all patients, and Dr. Janssen will assess candidacy during your pre-operative consultation.
The advantage of one-stage reconstruction is straightforward: you wake from mastectomy surgery with a breast implant already in place, and the overall timeline to completion is shortened. You avoid 8-12 weeks of weekly expansion clinic visits and the second surgical procedure to exchange the expander.
The principal consideration is that immediate implant placement requires precise surgical judgment about skin quality, blood supply, and the amount of soft tissue coverage available. If any concern exists about tissue viability or adequate coverage, the two-stage approach (tissue expander first) is safer and ultimately more reliable.
Yes, radiation can affect implant-based reconstruction. Radiation can increase the risk of capsular contracture (firmness of scar tissue around the implant) and may require implant replacement if significant contracture develops. If radiation is anticipated as part of your cancer treatment, this should be discussed explicitly with Dr. Janssen during pre-operative planning — it may influence the choice between implant-based and autologous (tissue-based) reconstruction, as autologous tissue is more biologically resilient to radiation.
Capsular contracture occurs when scar tissue around the implant becomes thickened and tight, causing the breast to feel firmer or become distorted. It is a known long-term complication of implant-based reconstruction, occurring in a percentage of patients. Modern implant designs and surgical techniques have reduced its incidence, but it remains a possibility that patients should understand. If significant contracture develops, it can be treated with revision surgery.
Implants are not designed with a preset expiration date, but they are not lifetime devices. They may eventually require replacement due to rupture, contracture, cosmetic changes, or patient preference. Most patients go many years without needing replacement, but it is important to understand that implants may eventually need intervention or exchange.
Expansion typically occurs over 8-12 weeks, with weekly or biweekly clinic visits. The exact timeline depends on how much your skin needs to stretch to accommodate your desired breast size and your body's healing response. Dr. Janssen will discuss the anticipated timeline during your initial consultation.
Yes. Both breasts can be reconstructed with implants placed at the same surgery, or one at a time, depending on your preference and medical circumstances. Dr. Janssen will discuss the most appropriate approach during consultation.
Silicone gel implants provide a soft, natural feel that closely mimics natural breast tissue. Saline implants are filled with sterile salt water and can be adjusted in volume at the time of surgery. Both are safe and FDA-approved. Silicone is generally preferred in reconstruction because of its superior feel and lower visibility of any surface irregularities. Dr. Janssen will recommend the most appropriate option based on your tissue coverage and goals.
Yes. Once your implant reconstruction has healed (typically 3-6 months after implant placement), fat grafting can be used to fill depressions, improve implant rippling, or refine overall breast contour. These refinement procedures are performed as outpatient procedures and allow progressive optimization of your result.
Complications such as infection, seroma (fluid collection), or implant displacement can occur and are managed based on the specific circumstance. Most minor complications are resolved with office-based care or simple procedures. More significant issues may require revision surgery. Dr. Janssen maintains close follow-up and is prepared to address any complications that arise.
