Implant reconstruction

Implant reconstruction involves putting a breast implant under the muscle and skin of the breast. A breast implant is like a balloon, with silicone (like rubber or plastic) on the outside, and either silicone or saline on the inside. Implants are the most common way of getting breast reconstruction.

Implants are available in different shapes and sizes. They may be a good option if you do not have very large breasts or you cannot use tissue from other parts of your body to create a breast.

Types of implants

Silicone implants are filled with semi-solid silicone gel. They feel similar to a natural breast in texture and shape. Recent studies suggest silicone implants are safe and do not cause immune system diseases or other health problems. You can find information about the safety of breast implants from the FDA.

A newer type of silicone implant called a highly cohesive gummy bear, or style 410, implant is now available. These implants are shaped rather than round and offer a more natural breast shape.

Saline implants, which consist of a silicone shell filled with a salt water solution called saline, are used more often than silicone. Saline-filled breast implants feel more like a water balloon. They are more likely than silicone to cause ripples, and can feel cooler to the touch. They may feel less firm than silicone implants.

Silicone implants feel somewhat more natural than saline. But if they leak, they leak silicone. Saline implants just leak the salt water they contain. Saline implants do not need to be checked for leakage because it is obvious when they leak.

Talk with your doctor about your implant options to make the best choices for you.

How implant reconstruction works

Usually, implant-based reconstruction is done in two stages. First, an implant shell called a tissue expander is inserted into your chest. In some, but not all, cases regenerative tissue from a donor is used to hold this expander in place. Every few weeks your surgeon will expand the muscle and breast tissue by injecting saline into the port that is under the skin and connected to or inside the tissue expander. This process can be uncomfortable, but most people do not have a lot of pain. It requires frequent office visits.

When the breast reaches the desired size, you then have a second surgery, under general anesthesia, in which the expander is replaced with either a saline or silicone implant.

With single-stage or direct-to-implant reconstruction, a plastic surgeon inserts the full implant under the muscle on your chest, using regenerative tissue to hold it in place, during the mastectomy surgery.

Radiation therapy after breast implant reconstruction

If you need radiation therapy after mastectomy, your doctor will likely recommend delayed reconstruction. Sometimes it is possible to have implant reconstruction before radiation therapy. But there is higher risk for complications and poor-looking results if an implant is radiated.

Research suggests that women who have breast implant reconstruction followed by radiation therapy are not as happy with the results as women who have the same reconstruction without radiation therapy. They report lower levels of well-being. When considering radiation therapy after implant reconstruction surgery, talk to your doctor about balancing your cancer care with other issues important to you.

Pros & cons of implant reconstruction

Pros of implants include:

• Better ability to control breast size
• Shorter recovery time than surgery for tissue reconstruction
• No extra scars on other areas of your body from moving tissues around

Cons of implants include:

• Potential for more surgery if the implants rupture or leak, or if you have capsular contracture, where scars form and harden around the implants.
• While the unaffected breast sags with age, the implant remains high and “perky.” Talk with your surgeon if you are not happy with the look of your breasts, or if your breasts age at different rates. You may be able to change the type or shape of the implant or reconstruct to a flap altogether.

The FDA recommends getting an MRI three years after your implant and then every 2 years to assess the implant and monitor for any tears or leaks.