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The goal in an implant-based breast reconstruction is to achieve optimal tissue coverage of the implant.

Implant-based reconstruction

An implant has a well-determined volume that cannot be changed. The challenge in implant-based breast reconstruction is to achieve a maximal and sufficient tissue coverage of the implant. This can be challenging as often only the skin is available to cover the implant. This is the reason why implants are often positioned behind the pectoral muscle. At the long-term, a position behind the muscle could result in breast deformity and breast animation.

To avoid a position behind the muscle the option of a hybrid breast reconstruction could be considered. The implant is positioned in front of the muscle and additional lipofilling is performed to add extra volume and coverage of the implant.


Possible complications related to implant-based breast reconstruction are:

  • capsular contraction due to scar formation around the implant
  • infection
  • migration or displacement of the implant
  • discomfort or pain
  • a cold feel and touch of the reconstructed breast
  • ALCL

Expander first, then implant

Very often an expander is initially inserted to control the expansion of the skin. The advantage is that an expander is a temporarily solution and the surgeon has a better control of the breast shape. It will be easier to insert the correct volume of the final implant and with the hybrid breast reconstruction approach lipofilling is used to restore the subcutaneous tissue layers. Especially patients who had irradiation therapy will benefit from the expander insertion.


It is advised to perform additional lipofilling procedures when an implant is chosen to reconstruct the breast. Lipofilling will add better coverage of the implant and the breast will look and feel more natural.


The expander

The video shows you the latest generation of breast implants. Two weeks after the insertion they are expanded at the outpatient clinic with sterile, physiologic water.