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 ​Mo Salhab MD, MS, PG Dip, FRCS 

​Oncoplastic & Aesthetic Breast Surgeon

contact@ibreast.uk

​​Private Sec:  01274550842     

​Clinic Bookings: 01274550615

Bilateral nipple sparing mastectomy and Implant reconstruction 

Bilateral nipple sparing mastectomy and Implant reconstruction Before and after

Left breast implant reconstruction with right breast augmentation followed by left nipple reconstruction

Potential advantages


  • Shorter operation time, hospital stay and quicker  recovery
  • Fewer scars and avoidance of donor site operation and potential complications such as bleeding, infection, and pain.
  • It allows the surgeon to get better control of the final size of the reconstructed breast.


Potential disadvantages


  • Multiple operations to achieve the desired size and symmetry.
  • Implant complications such as capsular contracture ( scar tissue formation) and risk of implant rupture
  • Risk of implant infection requiring removal.
  • Risk of skin necrosis if the skin is expanded too much.

One Stage implant Breast Reconstruction


This technique is used in immediate breast reconstruction after skin or nipple-sparing mastectomy. It involves placement of an implant in the breast pocket behind the chest muscle without prior expansion, meaning a second operation is not usually needed.


In this operation, the upper half of the implant is covered by the pectoralis major muscle (chest wall muscle) and the lower half is usually covered and supported by a biological mesh called acellular dermal matrix (ADM). Different types of acellular dermal matrix have been developed.

Mr. Salhab commonly uses  Acellular Dermal Matrix mesh which has been proven to be safe to use, it is used in breast reconstructive surgery due to its multiple benefits mainly:


  • Better cosmetic results by providing additional coverage of the implant, it also helps control implant location by acting as an internal bra, it helps to define the infra-mammary and lateral mammary ceases.  Hence, creating a more natural-looking breast.
  • It helps the surgeon control the pocket size which may minimize complications such as rotation of the implant. In addition, it helps mask breast implant visibility; helps prevent bottoming out or extrusion of the implant.
  • Using a mesh limits the extent of chest wall muscles. Furthermore, it masks the appearance of implant wrinkles or ripples and irregular contours by supporting the implant. 


Potential benefits 

When compared to other reconstructive techniques include the following: 


  • No donor site scars or complications associated with autologous flaps reconstruction or elevation of other chest wall muscles.
  • Reduced initial operative time and the overall number of operations 
  • Reduced recovery time and quicker return of normal body image 
  • Improved overall aesthetic results.


Potential disadvantages

  • May require future operations to optimise the appearance of the breast or deal with long term complications
  • Risk of infection and implant loss
  • Risk of capsular contracture and implant rupture
  • Possible differences in shape and size between breasts.


The following video illustrates how one-stage implant reconstruction with ADM


Two-stage Implant Breast reconstruction


This technique is also called Tissue Expander-to-Implant Breast Reconstruction. It consists of two surgical stages, the first stage involves placing an expander under the chest muscles to create a breast pocket, Saline is then added to the expander via a port in the outpatient clinic at different occasions until the desired breast pocket size is achieved.

Patients will often feel stretching and tightness in the chest wall when the tissue expander is being filled, this feeling is tolerated by most patients and the amount of added saline to the expander can be adjusted so the patient keeps comfortable.  The expander is generally inflated until the new breast is just larger than the other one, and then left for about three months so the skin stretches.

Once the desired breast pocket size is achieved,  the  second stage of the reconstruction  is performed to replace the expander with a permanent implant to create the breast mound

Implant Reconstruction


Implant reconstruction offers patients who are undergoing or who had mastectomy different techniques to re-build a breast. Each method has advantages and disadvantages.


The choice of method depends largely on the type of mastectomy, scarring, other cancer treatment after surgery and a woman's individual preference and expectations.

Implant reconstruction tends to create a more round and firm new breast that may sit higher on the chest and droop less with age compared to breasts reconstructed using a woman's own tissue. Therefore, women considering implant-based reconstruction may also consider surgery on the other healthy breast such as a lift or mastopexy to achieve symmetry


Learn more about breast implants by visiting the Medicines and Healthcare products Regulatory Agency (MHRA) 

Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf
Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf

Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf

Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf
Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf

Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf

Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf
Implant reconstruction offers a surgeon many different techniques to re-build a breast post-mastectomy. Each method has advantages and disadvantages. The choice of method depends largely on a woman's individual preference and her cancer treatment plan. Breasts reconstructed using an implant tend to be more round and firm (and to move less naturally) than those using a woman's own tissue. It is important to note that the newly formed breast reconstructed with implants may droop less with age and may sit higher than the natural breast. It's also worth noting that, at some point, a woman may need further operations to the reconstructed breast, or even to the natural breast, in order to achieve symmetry after the initial reconstruction. - See more at: http://www.breastreconstructionmatters.co.uk/implant.html#sthash.ZMZfAZNX.dpuf