Breast reconstruction with an expander prosthesis

A silicone implant is a good option for a slim patient who does not have enough tissue of her own to be used for breast reconstruction. It is common for the mastectomy scar to be a little tight, and therefore it needs to be gradually stretched. A pocket is made under the pectoral (chest) muscle and an acellular dermal matrix is used to support its lower and outer part. An empty expander is then inserted into the pocket.

After the incision has healed, the process of gradually filling the expander prosthesis with saline solution is started. Saline solution can be added to the expander 1-2 times a week, depending on the flexibility of the skin and the scar. The expander is filled until it is slightly larger than the planned implant. Once the expansion is complete and the skin tightness has returned to normal, the tissue expander is exchanged for an implant. It is also possible to choose other reconstruction methods for replacing an expander in the pocket. See the picture below.

Finally, a nipple is reconstructed using a skin flap and, once these incisions have healed, an areola is tattooed around the reconstructed nipple.

Photo: In the picture an expander and acellular matrix (Artia™ ) support has been left under mastectomy scar during cancer operation in patient’s left breast. The skin of original breast was removed. After two years’ recovery,a tattoo the left breast was reconstructed with LD-flap and an implant. A nipple has been reconstructed later with a small local flap and tattoo.

“Acellularmatrix (for example. Artia™) is a central tool in expander prothesis breast reconstructions!”

Artia™ is a product manufactured by Allergan and it is derived from porcine skin. It is a sterilised, surgical mesh, which has been laboratory processed to take out the living cells that could cause antibody formation (minimizing the 1,3 alpha galactose-epitope synthesis).

Artia™ can be used underneath the skin to support the tissue. It works well when supporting the breast implant pocket, but it can also be used in large hernia operations as a hernia repair.

Studies have shown that it does not prevent blood vessel forming (angiogenesis) nor does it interfere with white or other cell growth hence the infection risk for Artia™ use is not elevated.