BREAST RECONSTRUCTION USING MOTIVA ERGONOMIX IMPLANTS

Breast reconstruction is one of the commonest types of reconstructive surgery performed in Singapore because breast cancer is the commonest female cancer in Singapore, with an incidence of about 1 in 11 women. Each year, more than 1000 cases of breast cancer are diagnosed in our country.

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Many patients with breast cancer require a mastectomy. This procedure involves surgical removal of the breast containing the cancerous growth. If the diagnosis of breast cancer is made early when the tumor is small and other conditions are favorable, it may be possible for the mastectomy to be performed without having to sacrifice the skin or the nipple areolar complex of the breast.


Skin sparing and nipple sparing mastectomies

The skin sparing mastectomy involves removing the breast, the nipple and the areola, but no skin is removed. The nipple sparing mastectomy, also known as a subcutaneous mastectomy, involves removal of the breast tissue only, while sparing the nipple areolar complex and all of the skin. The choice between these types of mastectomy will depend on a number factors such as the size of the tumor, its location, and whether the milk ducts close to the nipple are involved. The nipple sparing/subcutaneous mastectomy is the least disfiguring of all mastectomy techniques, but it is only suitable when conditions are favorable and do not require the nipple areolar complex to be sacrificed.


Options for breast reconstruction

After a mastectomy, the breast can be reconstructed with an implant or the patient’s own tissues harvested from another part of the body, usually the back or the abdomen. Sometimes both options may be required. Each option has its pros and cons, and all options should be carefully considered before making an informed choice.


Choice of implant in implant based reconstruction

If an implant is the chosen method of reconstruction, the Motiva Ergonomix implant is the implant of choice. This implant is very soft, looks natural and moves naturally. It also has the lowest risk of capsular contracture, which is normally an important consideration anyway but even more important if postoperative radiation therapy is required. 


What is capsular contracture?

When an implant is placed in the body, the body’s immune system reacts to the presence of the implant by producing a layer of scar tissue around the implant. This layer of scar tissue is known as the capsule. If the capsule remains thin and soft, the implant feels normal. However, if the capsule becomes thick and contracts, the implant will feel too firm, and its shape will become too round. This is known as capsular contracture, and it spoils the result of the breast reconstruction. Certain types of breast implant are more prone to capsular contracture. The Motiva Ergonomix implant has the lowest capsular contracture rate of all implants (about 1%). This is a major reason for it being the preferred choice of implant for implant based breast reconstruction.

Keeping the risk of capsular contracture as low as possible is important because once it occurs, the breast will no longer feel soft and natural, and its shape will also become distorted. Furthermore, the only effective way to correct significant capsular contracture is reoperation, which involves a capsulectomy (surgical removal of the capsule) and implant replacement).   


Radiation therapy and capsular contracture

When an implant reconstructed breast is subjected to radiation therapy, there is a significant risk of capsular contracture occurring. This is because the radiation energy stimulates an inflammatory response in the breast implant capsule mediated by the body’s immune system, which then leads to thickening and contraction of the breast implant capsule. Therefore, it is important to use an implant that is resistant to capsular contracture, so that the risk of capsular contracture can be mitigated as much as possible. Hence the preferred choice of the Motiva Ergonomix implant.


ALCL

ALCL stands for Anaplastic Large Cell Lymphoma. It is a kind of lymph node cancer which has rarely been associated with textured breast implants. Since ALCL is a type of cancer, it is preferable to choose an implant that has not been associated with ALCL. Motiva implants have been used for more than 10 years, and more than one million implants have been implanted in patients. Thus far, there have been no reported cases of ALCL among patients with Motiva implants.  


The role of fat grafting in breast reconstruction

Whether the reconstruction is implant based or soft tissue based, fat grafting can be useful ancillary tool to fine tune and enhance the result of the reconstruction. Fat grafting involves removing fat cells from other parts of the body using gentle, non-traumatic liposuction technique, purifying the fat, then injecting the purified fat cells carefully and meticulously in small parcels into the areas that need it. Thus, fat grafting allows the plastic surgeon to add volume and tissue thickness to areas that need it in order to optimize breast size and breast shape and make the result look as natural as possible. It can be considered as an “icing on the cake” procedure that provides enhancement and refinement to the overall result.

Regardless of the method of reconstruction, with current advanced techniques and the availability of high quality breast implants such as the Motiva Ergonomix implant, it is often possible to fully reconstruct a breast following mastectomy and produce a new and natural looking breast.

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Symmetry and the opposite breast

Apart from restoring volume and shape in the reconstructed breast, we should also pay attention to the issue of symmetry with the opposite breast. If the opposite breast is significantly different from the reconstructed breast in terms of size or shape, it may be necessary to modify the opposite breast accordingly by performing a breast reduction (if the opposite breast is larger), a breast augmentation (if the opposite breast is smaller), or a breast lift (if the opposite breast is sagging).  

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