Breast reconstruction using an implant only - after risk-reducing mastectomy

An implant can be used:

• under the chest muscle in one operation
• with tissue expansion in one or two operations.

Breast reconstruction under the muscle (submuscular) Back to top

This type of reconstruction is suitable if you have a skin-sparing mastectomy| where some or all of the skin, and sometimes the nipple, is kept. An implant is put under the muscles covering the chest to replace the lost breast tissue.

This type of reconstruction is usually only possible if you are having relatively small breasts reconstructed. You can discuss with your surgeon whether the nipple can be preserved. Otherwise you may consider nipple reconstruction| or using artificial nipples.

The scar may be on either side of the nipple and continue sideways around it, or run in the crease under the breast. The scar may extend to the side of the breast.

An advantage of this method is that is usually looks good soon after the operation and is a simple procedure. However, the breasts won’t have their ‘normal’ droop and may appear higher than before. Also, the implant can change shape slightly as you move, as the overlying muscle contracts (shrinks). It’s therefore not always possible to produce a natural breast shape using this method in older women or in women with large breasts. Your surgeon will advise you about this.

Breast reconstruction using tissue expansion Back to top

Breast reconstruction involving tissue expansion can give very good results and avoids the extensive surgery involved in using tissue flaps|. However, it can take much longer to form a breast than other methods, and some women find this frustrating. Tissue expansion uses the ability of your skin and muscle to stretch. It is surprisingly elastic in most people and a natural breast form can usually be achieved in this way.

There are two ways of doing breast reconstruction using tissue expansion:

Two-stage surgery

First, an expandable implant (like an empty balloon) with a valve is put under the chest muscle. Small amounts of sterile salt water (saline) are injected into the valve under the skin to expand the implant. This is done weekly or fortnightly at the outpatient’s clinic.

You may feel a sensation of stretching and pressure in the breast area during this procedure, but it shouldn’t be too painful. The process continues until the breast is slightly larger than desired.

You then need to wait a few months for the skin to stretch. After this you will have a second operation where the fluid and inflatable bag are removed and a permanent, softer silicone implant is inserted. The previous over-expansion (increase in size) allows the breast to lie on the chest wall so it has a more natural appearance.

One-stage surgery

The second method is similar to the two-stage method but uses expandable silicone implants that stay in place. The implants have an outer chamber of silicone gel, and an inflatable inner chamber with an expansion valve. The inflatable inner chamber can be filled with salt water (saline) to allow the implant to be adjusted for size.

The implant is inflated over several weeks and left over-inflated for several more weeks to allow the skin to stretch. Some of the saline is then removed through the valve. A small operation, carried out under local anaesthetic as day surgery, is done to remove the valve.

When the expander is being inflated, it can be uncomfortable, making the breast feel tight and hard. This usually lasts only a day or so after each expansion. If you find it very uncomfortable, let your doctor know. They may remove some of the saline, and inflate the expander implant more slowly.

Tissue expansion can give a good appearance for some women, but sometimes it’s not as good as reconstruction using tissue flaps|. It’s not usually suitable for women who want large breasts.

With this type of breast reconstruction there will be a long scar (but this shouldn’t be any different from the mastectomy scar). There is also the need for several procedures before it is complete; several visits are needed to have the tissue expanders inflated. Also, the breasts will be relatively small until the expander has been inflated a few times. The reconstructed breasts will always be firmer than natural breasts and have little or no droop.

After complete healing from the above stages, a further procedure can be done if necessary to create a nipple.

This involves creating a nipple from skin over the implant.

An area can then be tattooed around this to make a more natural looking nipple and areola (the area of darker skin around the nipple).

Alternatively, you could consider using artificial nipples made of silicone (known as prosthetic nipples). These can be attached to the reconstructed breast using special glue. We have more information about options for nipple reconstruction| and tattooing.