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.
Your surgeon creates a breast mound by putting an implant into a natural space (or pocket) under your chest (pectoral) muscle. The muscle supports and protects the implant.
After a mastectomy, many women don’t have enough skin remaining on their chest to cover an implant and form a new breast. A two-stage procedure is used to overcome this.
First a special type of implant called a tissue expander is put under your chest muscle. The implant is expanded over time, stretching your chest tissue. Then, once your skin and muscle have fully stretched, you have a second operation. The surgeon takes out the tissue expander and puts an implant behind your chest muscle to create a breast shape.
A tissue expander is a bit like an empty balloon. It has an outer covering of silicone and a hollow chamber in the centre. Salt water (saline) can be injected through a valve (port) in the expander to increase its size. As the implant gets bigger, the skin and muscle covering it expand to form a breast shape.
After an operation to place the expander under your chest muscle, it takes a few weeks for the tissue to heal. Then the process of gradually stretching your skin and muscle to form your new breast begins.
You’ll have appointments at the outpatient clinic every 1-2 weeks, where a nurse or doctor will inject salt water (saline) into the expander through a port just under the skin of your chest or underarm. This only takes a few minutes. You may feel some aching or tightness in the breast area for a day or two after each injection, but it shouldn’t be painful. This process continues until your new breast shape is slightly larger than your other breast. Slightly over expanding the tissue will help the new breast have a more natural droop when its size is eventually matched to your other breast.
Once the implant is expanded to its final size, it is left for a few months to allow the skin to stretch fully. You’ll then have a second operation to have the expander taken out and a permanent silicone implant put into the space under your chest muscle. This gives you your final breast shape. Sometimes a permanent expander is used, and the expander stays in place. Once the skin has fully stretched, some saline is removed through the port until the size of the new breast matches the other breast. You then have a small operation, under a local anaesthetic, to remove the port.
Implants may be suitable for women who:
are having surgery to reconstruct both breasts at the same time.
may not be fit for longer operations.
have small breasts. (Women with large breasts, or breasts that droop, may still have implant reconstruction but will need to have a special type of mastectomy called a skin-reducing mastectomy. This can leave long scars and would be done for both breasts).
Implants are not usually suitable for women who have:
unresolved concerns about implants
had radiotherapy to the chest
had an operation to remove both the breast and the muscle underneath the breast (radical mastectomy) - this is because the chest muscle is needed to hold an implant in place.
It is a simple operation, usually lasting 2-3 hours, with a slightly shorter recovery time than other types of reconstruction.
It leaves less scarring on the breast and no scars elsewhere on your body.
It can give a good appearance, particularly for women with small breasts or women having both breasts reconstructed.
Several visits to hospital may be required for tissue expansion, over the course of a few months.
The operation will leave a scar. This may be on either side of the nipple and continue sideways around it, or run in the crease under the breast. If the implant is being put in as a delayed reconstruction, the surgeon may reuse the mastectomy scar to avoid a new scar.
Implants give a less natural look and 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 as the natural breast and can sit higher, especially out of a bra when your natural breast may droop more. In a bra it can give a fuller appearance above the bra line. Implant reconstructed breasts are slightly flatter and so do not fill the tip of the bra as well as your natural breast.
After a few years, surgery is sometimes needed to keep the breasts looking balanced (symmetrical). This is because, over time, the natural breast droops more than the new breast.
The implant can change shape slightly when the muscle over the implant tightens (contracts) during some movements.
Very slim women may be able to see a rippling effect through their skin caused by creasing or folds in the implant. There are some newer techniques that may help to minimise this.
Implants have a limited lifespan (10-15 years), so you may need further surgery in the future to replace them.
You may need further surgery if you put on or lose a lot of weight.
After any operation there is a risk of problems immediately afterwards, such as bleeding, pain, wound infection and bruising.
Most women don’t have too many problems, but possible problems include:
It’s uncommon to have an infection in the tissue around the implant. But, if this happens, the implant usually has to be taken out until the infection has cleared. The implant can then be replaced with a new one. Up to 1 in 10 women (10%) who have a breast implant may need to have it removed and replaced due to infection. You’ll be given antibiotics at the time of your operation to reduce the risk of infection.
Tightening or hardening of tissue around the implant (capsular contracture)
A breast implant is not a natural part of you so it’s normal for your body to try 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 1 in 10 women (10%) the capsule can become very tight. This is called capsular contracture, and 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 breast implant is not a natural part of you so it’s normal for your body to try 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 1 in 10 women (10%) the capsule can become very tight. This is called , and 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.
The risk of capsular contracture is increased in women who smoke or have an infection in their breast. It can be as high as 1 in 2 (50%) for women who have had radiotherapy to their chest. Many surgeons use implants with a textured outer layer as these are less likely to cause capsular contracture.
Damage (rupture) to implants
It is very difficult to damage implants so 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 of the implant is damaged. However, even if silicone does leak it is not dangerous to your health.
Saline-filled implants are not commonly used in the UK as they are more likely to leak and don’t look or feel as natural as silicone implants. If saline leaks out of an expander device it does not cause any harm.
Safety and breast implants
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In the past, concerns have been raised about whether implants containing silicone could cause health problems linked to the immune system (autoimmune conditions). An independent review carried out in 1998 to look into this found no link between silicone implants and autoimmune conditions. In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) ensures the safety of breast implants. It believes there is no reason to stop using silicone implants. You can read the independent review report and information for women considering breast implants on the MHRA website.
Radiotherapy and breast implant reconstruction
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If you are going to have radiotherapy after a mastectomy, implants may be used as part of a two-stage reconstruction. The implant can help to preserve the extra breast skin until you are ready for a full reconstruction, which involves a second operation about a year after radiotherapy. The reconstruction takes place when the implant is removed, either with a permanent silicone implant or more usually using your own tissue.
If you have a tissue expander, some doctors prefer to do the expansion before you start radiotherapy. Others prefer to do it when you have completed radiotherapy. Sometimes fluid is removed from the expander during radiotherapy. The expander is then re-inflated a few weeks after radiotherapy finishes.
Implants and mammograms
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Implants can make mammograms (breast x-rays) more difficult to read. If you’ve had a mastectomy you won’t need to have mammograms of the reconstructed breast, so this doesn’t usually matter. However, if you have an implant put in after a lumpectomy you should continue to have mammograms of the reconstructed breast.
You’ll need to tell the person doing the mammogram (usually a radiographer) that you have an implant so that they can use the most appropriate screening method for you.
If cancer occurs or comes back in a breast that has an implant, the cancer is just as likely to be detected at an early stage as in a breast without an implant.