Breast reconstruction using an implant

Breast reconstruction with implants is a simple operation. It takes 2–3 hours and has a shorter recovery time than other types of reconstruction.

Implants may be suitable for you if you are:

  • having both breasts reconstructed
  • not fit for a longer operation.

Implants can be put in as a one-stage or two-stage operation.

  • One-stage procedure - The surgeon puts a permanent implant under your chest muscle. If your chest muscle needs stretched they will use an expandable implant which they gradually inject saline into for a few weeks until the breast shape is the right size.
  • Two-stage procedure - A temporary expandable implant is put in. Once the breast shape is the right size the surgeon takes the expander out and replaces it with a permanent silicone implant.

After an implant operation you may have some bruising and discomfort. Sometimes the tissue round the implant hardens changing the feel and look of the breast. This is called capsular contracture. If it happens the implant may need to be removed.

Implants used in the UK are approved as safe.

Reconstruction using a breast implant

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.


One-stage procedure

In a one-stage procedure either a permanent silicone implant or an expandable implant is put under your chest muscle.

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 saline 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.

You 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. 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.


Two-stage procedure

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.

Breast tissue expander
Breast tissue expander

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Inflated breast tissue expander
Inflated breast tissue expander

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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 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.

Permanent silicone implant
Permanent silicone implant

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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 known as lipomodelling. Lipomodelling can be used to improve the shape and appearance of the breast.

Reconstruction of both breasts with expander implants
Reconstruction of both breasts with expander implants

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Reconstruction of both-breasts with expander implants and nipple reconstruction
Reconstruction of both-breasts with expander implants and nipple reconstruction

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New methods in implant surgery

Sometimes the surgeon may use a type of mesh (called an acellular dermal matrix or 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.

Acellular matrix materials are new in breast reconstruction and are not used by every breast surgeon. Your surgeon can talk through the possible advantages and disadvantages with you.


Are implants suitable for me?

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.
  • want to have an immediate reconstruction but who will need to have radiotherapy after mastectomy. In this situation a temporary implant may be used to preserve skin. Breast reconstruction using tissue for 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:

  • concerns about implants
  • had radiotherapy to the chest.


Benefits

  • 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.


Limitations

  • You may need several visits to 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 reuse the mastectomy scar to avoid 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 as the natural breast and can sit higher than your natural breast.
  • In a bra the new breast may look fuller 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.
  • 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).
  • If you still have one natural breast, you may need surgery in the future to keep your breasts looking balanced (symmetrical). For example if over time the natural breast droops more than the new breast or, if you put on – or lose – a lot of weight.
  • You may need surgery to replace implants if they leak (rupture) or cause tightening of the scar around the implant (capsular contracture).


Risks

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:

Infection

It is 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 will 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 to 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 of the implant is damaged.

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. But, the implant will go flat and need to be replaced.


Safety and silicone breast implants

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 autoimmune 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. 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 are concerned about having breast implants, it is 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.


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, if you’ve had breast cancer, 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 (not all of the breast is removed). In these cases, 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 so that they can use the most appropriate screening method for you.


Back to Types of breast reconstruction

Using your own tissue (flap reconstruction)

Reconstruction using your own tissue can give a natural feel to reconstructed breasts.

Using tissue from your back

A new breast shape can be made from muscle, fat and skin taken from the back. This is called an LD flap.

Using tissue from your tummy area

A new breast shape may be created using a flap of skin, fat and sometimes muscle from your tummy area.

Using tissue from the thighs or buttocks

New breast shapes can be made from fat and skin taken from your buttock or thighs.

Lipomodelling after breast reconstruction

Lipomodelling involves a doctor injecting fat from elsewhere in your body into your reconstructed breast to improve the look and feel of it.

Reconstruction after breast conserving surgery

If a large amount of tissue is removed from your breast, reconstructive surgery can improve how your breasts look.

Surgery to the other breast

Some women have an operation on their natural breast so that the reconstructed and natural breasts look as similar as possible.

Nipple reconstruction

Nipple reconstruction is usually done 4-6 months after breast reconstruction.