If after a mastectomy and full reconstruction the implant is showing to be too heavy for the chest to support causing the incision to widen placing the patient at risk of exposure, how is that treated? Is there anything that can be done before extrusion happens to hopefully avoid that from happening?
Adding more support to the reconstruction may be necessary. This could be by using an ADM like alloderm.
Thanks for your question:
If you feel that your implant is too big or feel that it is at risk for exposure then I would visit your operating surgeon for all of your options. After a mastectomy and subsequent tissue expansion the skin is very thin and implants have a tendency to become visibility and have ripples. This necessarily does not means it’s at risk for extrusion.
In a case like this, I would give my patients the option of fat grafting, to decrease implant visibility or if they are a candidate for a tissue based reconstruction, I would offer them a procedure such as a DIEP flap and get rid of the implant all together.
In this situation, it is best to downsize the implant, revise the breast, and reinforce the pocket with acellular dermal matrix. The dermal matrix acts as a strong leather sling to support the repair, relieving the skin of the stress of supporting the implant. The result is a fine scar, and a lasting result.
Thank you for sharing your excellent question. At times a skin substitute to bolster the skin can be performed while a smaller implant would also be advisable. Hope this helps.