Reconstruction by prosthesis

The shape and volume of the breast are reconstituted by an implant, usually anatomically shaped, consisting of a silicone shell most often filled with silicone gel.

The preoperative consultation allows the surgeon to determine with you the ideal dimensions of the prosthesis. Lipofillings are frequently associated to perfect the shape of the breast.

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Reconstruction technique by prosthesis

The prosthesis is inserted through the mastectomy scar. In case of delayed reconstruction, it is possible to use the skin under the submammary fold to recreate the lower part of the breast (abdominal advancement flap). Drains (Redon) are put in place to evacuate the lymph. They will be removed after a few days.

Modality of the intervention for a reconstruction by prosthesis

The length of hospital stay varies from 24 hours (one night) to 72 hours.

The procedure lasts between 1h30 and 2h30. It is performed under general anesthesia.

Most often, the pain of this procedure is very moderate: locoregional anesthesia is systematically used at the end of the operation, which represents a major progress in the care of postoperative pain.

After the operation, the dressings are kept for 8 to 10 days.

All sports activities are forbidden for about a month.
The intervention for a prosthesis is covered by social security.

Before / After prosthesis reconstruction

Below are a few photos that give an idea of the results that can be expected from breast reconstruction with prostheses.

Poitrine avant mastectomie gauche reconstruction immediate par prothese et filling prothese sein droit et redrapage institut du sein paris

Poitrine apres mastectomie gauche reconstruction immediate par prothese et filling prothese sein droit et redrapage institut du sein paris

1. Left mastectomy and immediate reconstruction by prosthesis and lipofilling. Augmentation of the right breast by prosthesis and treatment of ptosis by a scar around the areola.

Poitrine avant reconstruction sein gauche par prothese et filling institut du sein paris

Poitrine apres reconstruction sein gauche par prothese et filling institut du sein paris

2. Left mastectomy. Reconstruction by prosthesis and lipofilling. Bilateral areola prosthesis.

Poitrine avant reconstruction apres radiotherapie prothese et lipofilling prothese sein gauche institut du sein paris

Poitrine apres reconstruction apres radiotherapie prothese et lipofilling prothese sein gauche institut du sein paris

3. Right mastectomy and radiotherapy. Reconstruction by prosthesis and lipofilling. Augmentation of the left breast by prosthesis.

Poitrine avant reconstruction apres radiotherapie prothese et lipofilling redrapage et prothese sein droit institut du sein paris

Poitrine apres reconstruction apres radiotherapie prothese et lipofilling redrapage et prothese sein droit institut du sein paris

4. Left mastectomy and radiotherapy. Reconstruction by prosthesis. Augmentation of the right breast by prosthesis and treatment of ptosis.

5. Right mastectomy and radiotherapy. Reconstruction by prosthesis and lipofilling. Augmentation of the left breast by prosthesis.

Poitrine avant reconstruction apres radiotherapie prothese et lipofilling prothese sein droit institut du sein paris

Poitrine apres reconstruction apres radiotherapie prothese et lipofilling prothese sein droit institut du sein paris

6. Left mastectomy and radiotherapy. Reconstruction by prosthesis and lipofilling. Augmentation of the right breast by prosthesis.

Poitrine avec mastectomie prophylactique avant la reconstruction par protheses l'institut du sein paris

Des seins avec mastectomie prophylactique apres reconstruction par protheses a l'institut du sein paris

7. Left mastectomy. Reconstruction by prosthesis. Right prophylactic mastectomy, reconstruction by prosthesis.

Possible complications after reconstruction with prostheses

The risk of complication is low. At the Paris Breast Center we systematically evaluate our results: the implant removal rate is less than 3% (10% on average in the medical literature).

A distinction is made between early complications (within the first two months) and late complications.

Early complications:

Hematoma.
Infection: the introduction of a foreign body involves an infectious risk increased by radiotherapy. It is most often treated with antibiotics but can rarely lead to the removal of the implant.
The disunion of the scar which can lead to the removal of the implant.
Skin necrosis, especially in immediate reconstruction.

Late complications:

The placement of an implant induces the formation of a scar around the prosthesis called a capsule which isolates it from the surrounding tissues. The quality of the reconstruction depends on the flexibility of this capsule. The more rigid it is (creation of a shell), the more rigid the reconstruction will be. Radiation therapy increases the risk of a shell.
Asymmetry between the two breasts: even in the ideal case where reconstruction results in excellent symmetry, the reconstructed breast and the “natural” breast will age differently, which will lead to asymmetry over the years. This is easily corrected when it becomes embarrassing.
The rupture of the prosthesis. This is not strictly speaking a complication, there is no risk to your health. All prostheses wear out over the years, sometimes decades. It is the radiologist who detects the wear of the implant by ultrasound. The prosthesis is then changed without difficulty. On the other hand, there is no need to make a preventive change of the prosthesis, as some implants are intact more than 20 years after their installation.
Large Cell Anaplastic Lymphoma. This is an exceptional complication (estimated risk of one case in 80,000 prostheses) which concerns prostheses with a macro-textured surface, now banned in France.

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