Breast reconstruction using an implant
This method is often used for immediate reconstruction and for women having reconstruction to both breasts.
Breast implants are made of a silicone outer cover with either silicone gel or salt water (saline) inside. They come in a range of sizes and can be tear-drop or round in shape. The outer surface may be smooth or textured.
Reconstruction using an implant can be a one-stage or two-stage procedure.
In a one-stage procedure, either an implant on its own or a special type of implant called an expandable implant is put under your chest muscle.
If you have had a skin-sparing mastectomy, the muscle in your chest wall may not need to be stretched.
Your surgeon may be able to put in a permanent silicone implant without the need for an expandable implant.
An expandable implant has an outer chamber of silicone gel and an inflatable, hollow inner chamber with a valve (port). Salt water (saline) can be injected through the valve into the hollow inner chamber to expand it. This stretches the muscle covering the expander to form the new breast shape.
After an operation to place the expandable implant under your chest muscle, it takes a few weeks for the tissue to heal. Then the process of gradually stretching your muscle to form your new breast begins.
Yesterday I went back to have some of the saline taken out. And that makes them a little bit smaller – the size I want now. They are softer like they were before. The recovery was good. I’m very pleased with the results.’
(Had expandable implants in both breasts)
You will have appointments at the outpatient clinic every 1–2 weeks, where a nurse or doctor injects salt water (saline) into the expandable implant through a valve just under the skin of your underarm. This only takes a few minutes each time. You may feel some aching or tightness in the breast area for a day or two after each injection, but it should not be painful. This process continues over several weeks.
Sometimes an expandable implant is over-inflated slightly to allow the muscle to stretch.
Once the skin has fully stretched, some saline is removed through the valve until the size of the new breast matches the other breast. Slightly overstretching the muscle will help the new breast have a more natural appearance.
The surgeon then takes the valve out during a small operation carried out under a local anaesthetic.
In a two-stage procedure, a temporary tissue expander is put under the chest muscle to stretch it. A temporary tissue expander has a hollow inner chamber, but not a silicone gel outer chamber like a permanent expandable implant.
Using a butterfly needle, a nurse or doctor injects salt water into the expander through a valve just under the skin of the chest.
This increases its size and stretches the chest muscle to form the breast shape.
Once the temporary implant has expanded to its final size, it stays in place for a few months to allow the muscle to stretch fully.
You will then have a second operation to have the implant taken out and a permanent silicone implant put into the space under your chest muscle. This gives you your final breast shape.
After there has been complete healing from the one- or two-stage implant procedure, a further procedure can be done to create nipples, if desired.
Women who have implants may also benefit from a new procedure called lipomodelling. Lipomodelling can be used to improve the shape and appearance of the breast.
New methods in implant surgery
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Sometimes the surgeon may use a type of mesh called an acellular dermal matrix (ADM) to help support an implant. ADM is a tissue-like substance made from pig skin, cow skin or other natural substances.
The surgeon attaches the mesh to the chest (pectoral) muscle and the chest wall to create a sling. This holds the lower part of the implant in place and helps to give the breast a natural droop.
ADM materials are new in breast reconstruction and are not used by every breast surgeon. Your surgeon can talk through the possible advantages and disadvantages of it with you.
Are implants suitable for me?
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Implants may be suitable for women who:
are having surgery to reconstruct both breasts at the same time
may not be fit enough for longer operations
want to have an immediate reconstruction but who will need to have radiotherapy after a mastectomy. In this situation, a temporary implant may be used to preserve the skin. Breast reconstruction using tissue from another part of the body may then be used to reconstruct the breast shape after radiotherapy.
Implants are not usually suitable for women who have:
Having an implant put into the breast is a simple operation that usually lasts 2–3 hours. It has a slightly shorter recovery time than other types of reconstruction.
It leaves less scarring on the breast and no scars elsewhere on your body.
The breast outline can look balanced in clothes.
It can give a good appearance, particularly for women with small breasts or women having both breasts reconstructed.
You may need several visits to the hospital for tissue expansion over the course of a few months.
The operation will leave a scar. If the implant is being put in as a delayed reconstruction, the surgeon may re-use the mastectomy scar to avoid making a new scar.
Up to 10% of women (1 in 10) who have breast reconstruction using implants may need to have the implants taken out due to infection or problems with wound healing.
Implants don’t feel as soft or as warm as a breast formed using your own tissue.
The new breast may not have the same droop asthe natural breast and can sit higher than your natural breast.
In a bra, the new breast may look fuller above the bra line. A breast that is reconstructed with an implant is slightly flatter and so won’t fill the tip of the bra as well as your natural breast.
The implant can change shape slightly when the muscle over the implant tightens (contracts) during some movements.
Some women may be able to see a rippling effect through their skin caused by creasing or folds in the implant.
Reconstructed breasts have little or no sensation (they feel numb).
You may need surgery in the future to keep your breasts looking balanced (symmetrical). For example, over time the natural breast may droop more than the new breast. Gaining or losing a lot of weight can also make a difference to the shape of your breasts.
You may need surgery to replace implants if they leak (rupture) or cause tightening of the scar around the implant.
After any operation, there is a risk of problems immediately afterwards, such as bleeding, pain, infection and bruising.
Most women don’t have many problems, but possible problems include the following.
It’s uncommon to have an infection in the tissue around the implant. But if this happens, the implant usually has to be removed until the infection clears. The implant can then be replaced with a new one. You’ll be given antibiotics at the time of your operation to reduce the risk of infection.
If an implant needs to be removed due to infection, the final appearance of the reconstructed breast may not be as good.
Tightening or hardening of tissue around the implant (capsular contracture)
A breast implant is not a natural part of you, so your body tries to keep it separate. It does this by forming a ‘capsule’ of scar tissue around the implant. Over a few months, the scar tissue shrinks (contracts) as part of the natural healing process. In about 10% of women (1 in 10), the capsule can become very tight. This is called capsular contracture. If it happens, your breast may feel hard, painful or change shape. Sometimes an operation is needed to remove the implant and replace it with a new one. A new procedure called lipomodelling can also sometimes be used to help with capsular contracture.
Smoking, infection and radiotherapy increase the risk of capsular contracture.
Damage (rupture) to implants
It is very difficult to damage implants. It’s fine to continue with your normal activities, including sports and air travel, without worrying that it will affect your implant. However, sometimes implants can split or tear. Most silicone implants contain a firm gel that is very unlikely to leak in significant amounts, even if the outer cover is damaged.
Saline-filled implants aren’t commonly used in the UK, as they’re more likely to leak and don’t look or feel as natural as silicone implants. If saline leaks out of an expander device, it won’t cause any harm. But, the implant will go flat and need to be replaced.
Safety of silicone breast implants
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A lot of research in different countries has been carried out to look into whether silicone implants cause health problems. No link has been found between silicone implants and the development of cancer or other conditions.
Recent concerns have focused on the quality of the silicone used to fill breast implants after French-made PIP breast implants were found to contain industrial- rather than medical-grade silicone filler. There were concerns that these implants could have a higher rate of rupture than other implants and a toxic effect if the unapproved silicone filling leaked out. Evidence shows that PIP implants are more likely to rupture than other implants, but there is no evidence that they can cause harm to health. PIP implants have not been used in the UK since 2010.
To comply with safety standards, all breast implants that are used in the UK must first be approved by The Medicines and Healthcare products Regulatory Agency (MHRA). This organisation is responsible for ensuring that medical devices, including breast implants, are safe and fit for use.
If you’re concerned about having breast implants, it’s important to discuss this with your surgeon before your surgery. They’ll be able to tell you what type of implants you’ll have and who makes them.
Implants and mammograms
Implants can make mammograms (breast x-rays) more difficult to read. If you have had a mastectomy, you won’t need to have mammograms of the reconstructed breast, but you may have an implant put into your other breast to balance the look of your breasts. Alternatively, you may have an implant put in after breast-conserving surgery (when not all of the breast is removed). In this case, you should continue to have mammograms of the reconstructed breast.
You will need to tell the person doing the mammogram (usually a radiographer) that you have an implant. This is so they can use the most appropriate screening method for you.