Breast reconstruction using a breast implant - after risk-reducing mastectomy
This is where an implant is placed under the skin and muscle that covers your chest to create a breast shape.
This type of reconstruction is suitable if you have a skin-sparing or nipple-sparing mastectomy where some or all of the skin and sometimes the nipple is kept.
It can be used for immediate reconstruction to both breasts. An implant is put under the muscles covering the chest to replace the lost tissue.
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 alone or a special type of implant called an implant/expander is put under your chest muscle.
Implant/expanders have an outer chamber of silicone gel and an inflatable hollow inner chamber with a valve (port). Salt water (saline) can be injected through the valves into the hollow saline chamber to expand them.
They are expanded over time so that the muscles covering them stretch to form the new breast shapes.
After an operation to place the implant/expanders 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 breasts 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 implant/expanders through a valve 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 over several weeks.
Reconstruction of both breasts with expander implants
and nipple reconstructions
Sometimes these implant/expanders are slightly over-inflated to allow the muscle to stretch. Slightly overstretching the muscle will help the new breasts have a more natural appearance. Some of the salt water is then removed through the valves. The valves are taken out during a small operation which is carried out under local anaesthetic.
Sometimes, following a skin-sparing mastectomy the chest wall muscles don’t need to be stretched to help form the new breast shapes. In this situation, permanent silicone implants are put in rather than implant/expanders.
Reconstruction of both breasts using implants (with nipple reconstruction)
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 implant/expander. Salt water is injected into it through a valve to increase its size and stretch the chest muscle to form the breast shape.
Once the temporary implants are expanded to their final size, they are left for a few months to allow the muscle to stretch fully. You’ll then have a second operation to have the implants taken out and permanent silicone implants 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. We have more detailed information about nipple reconstruction. Women who have implants may also benefit from a new procedure known as lipomodelling. Lipomodelling can be used to improve the shape and appearance of the breast.
Benefits and limitations of reconstruction using implants
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It’s a simple operation that usually lasts 3–5 hours when both breasts are reconstructed, with a slightly shorter recovery time than other types of reconstruction.
It leaves less scarring on the breasts and no scars elsewhere on your body.
It can give a good appearance, particularly for women with small breasts.
Several visits to hospital may be required for tissue expansion, over the course of a few months.
Further operations are usually needed to get the shape, appearance and size of the breasts to be similar and as good as possible.
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.
The operation will leave a scar on both breasts. This may be on either side of the nipple and continue sideways around it, or run in the crease under the breasts. If the implants are being put in as a delayed reconstruction, the surgeon may reuse the mastectomy scars to avoid new scars.
Implants give a less natural look and don’t feel as soft or as warm as a breast formed using your own tissue.
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. We have information about some newer techniques that may help to minimise this.
The reconstructed breasts will have little or no sensation.
After any operation there is a risk of problems immediately afterwards, such as bleeding, pain, wound infection and bruising.
Most women don’t have many problems, but possible problems after reconstruction using implants may 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 taken out until the infection has cleared. 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, and we have more information on infection.
If an implant needs to be removed for a period of time 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 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 10% of women (1 in 10) the capsule can become very tight. This is called capsular contracture, and if it happens your breast or breasts 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.
The risk of capsular contracture is increased in women who smoke or have an infection in their breast. 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’s 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 silicone breast implants
A lot of research in different countries has been carried out to see whether silicone implants cause health problems.
No link has been found between silicone implants and the development of cancer or auto-immune 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. Concerns were raised that these implants could have a higher rate of rupture than other implants and a toxic effect if the unapproved silicone filling leaked out.
Although evidence has found that PIP implants can rupture at a higher rate than other implants, there is no evidence that they have a toxic effect.
These implants were withdrawn from use in the UK and throughout Europe in 2010. A review is underway to investigate why these implants were used in the UK.
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 operation. Your surgeon will be able to tell you what type of implants you will have and who makes them.