About breast reconstruction using an implant

Breast implants are often used for:

The surgeon makes a breast shape by putting a breast implant under, or sometimes in front of, the chest muscle.

Breast implants have a silicone outer cover with silicone gel or salt water (saline) inside. They come in a range of sizes and can be round or teardrop-shaped.

Reconstruction using an implant can be a one-stage or two-stage procedure.

One-stage procedure

The surgeon puts either a fixed-size implant or an expandable implant under your chest muscle.

Fixed-size implant

The surgeon puts a permanent silicone implant under or sometimes in front of the muscle to create a new breast shape.

Surgical mesh

The surgeon may use a surgical mesh to support the implant and improve the shape of the reconstructed breast. It can be made from different materials, such as a synthetic material or a tissue-like material, made from animal or human tissue.

Supporting sling

Sometimes, the surgeon uses your own tissue to make a supporting sling for the implant. This may be suitable if you want your reconstructed breast to be smaller or more lifted.

The surgeon attaches the supporting material to the chest muscle and the chest wall to create a sling. This holds the lower part of the implant in place. It also helps give the breast a natural droop without stretching the chest muscle.

Your surgeon can explain the possible benefits and disadvantages of using a supporting material.

Expandable implant

If your chest muscle needs to be stretched, the surgeon can use an expandable implant. An expandable implant has an outer chamber of silicone gel and a hollow inner chamber. This inner chamber can be filled with saline through a valve (port).

The surgeon puts the expandable implant under your chest muscle. You then wait a few weeks for the tissues to heal. After this, the muscle and skin begin to stretch to form your new breast shape.

Saline injections

Every 1 to 2 weeks, a nurse or doctor injects saline into the implant. They do this through a port under the skin of your underarm. You may feel some aching or tightness in the breast area for a day or two after each injection. This process continues over several weeks.

After a few more weeks, once the muscle has been stretched, the nurse or doctor may remove some saline through the port. The surgeon can then take the port out during a small operation. The operation can be done under a local or general anaesthetic.

Two-stage procedure

  1. The surgeon puts a temporary tissue expander under the chest muscle to stretch it. A temporary tissue expander has a hollow inner chamber that can be filled with saline. But it does not have the silicone gel outer chamber that a permanent expandable implant has.
  2. A nurse or doctor injects saline into the expander through a port just under the skin of the chest. This increases the size of the expander and stretches the chest muscle to form the breast shape.
  3. Once the temporary implant has expanded to its final size, it stays in place for a few months. This allows the muscle to stretch fully.
  4. You then have an operation to have the implant taken out. At the same time, the surgeon puts a permanent silicone implant under your chest muscle. This gives you your final breast shape.

Breast tissue expander

   

A permanent silicone implant 

The expandable implant is removed and a permanent silicone implant is put in its place

 

Reconstruction of both breasts with expander implants

The photograph shows a woman who has had reconstruction of both breasts with expandable implants.

Reconstruction of both breasts with expander implants and nipple reconstruction

The photograph shows a woman who has had reconstruction of both breasts with expandable implants. She has also had nipple reconstruction and you can see scars on either side of each nipple.

Reconstruction of both breasts with expander implants without nipple reconstruction side view

The photograph shows a side view of a woman who has had reconstruction of both breasts using implants but without nipple reconstruction. There is a vertical scar from the nipple area to under the breast.

Reconstruction of both breasts with expander implants (without nipple reconstruction) front view

The photograph shows a front view of a woman who has had reconstruction of both breasts using implants but without nipple reconstruction. There are vertical scars from the nipple area to under the breasts.

What are the benefits?

  • It is an easier operation than other types of breast reconstruction.
  • It has a slightly shorter recovery time than other types of breast 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 who are having both breasts reconstructed.

What are the limitations?

  • You may need several visits to the hospital over a few months for tissue expansion.
  • The operation will leave a scar.
  • Implants do not feel as soft or as warm as breasts made using your own tissue.
  • To get the best result, you usually need more operations. This may be to reposition the implant. Or it may be done to add fat over the implant (lipomodelling) to improve the shape and give a more natural feel.
  • The reconstructed breast is unlikely to have the same droop as the natural breast.
  • Your natural breast changes over time, but the breast with the implant will not. This may mean that in future your breasts look less even. You may need surgery to lift your natural breast.
  • The implant may change in shape when the muscle over it tightens (contracts).
  • Some women may be able to see a rippling effect through their skin. This is caused by creasing or folds in the implant.
  • A reconstructed breast has less sensation than a natural breast. It may feel numb.
  • You may need surgery to replace an implant if it leaks or if the tissue around the implant tightens.

What are the risks?

With any operation, there are risks, such as infection. There are also some risks specific to implants.

Removal of the implant

Up to 1 in 10 women (10%) need to have an implant removed within the first 3 months after surgery. After 9 months, this will have gone up to 1 in 7 women (15%). This can happen because of wounds not healing properly, which can cause infection.

Smoking or having radiotherapy further increase the risk. Up to 1 in 5 women (20%) who smoke or who had radiotherapy after mastectomy need their implant removed.

If the implant needs to be removed, there will usually be a delay of a few months before a new implant is put in. During this time the breast will be flat. The delay is needed to give the tissues time to heal and to treat any infection.

Infection around the implant

It is rare 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 will be given antibiotics at the time of your operation to reduce the risk of infection.

If an implant needs to be removed because of infection, the final appearance of the reconstructed breast may not be as good. It is important to follow any advice you are given about preventing infection.

Tightening or hardening of tissue around the implant

A breast implant is not a natural part of you. Because of this your body reacts to it by forming a capsule of scar tissue around the implant.

Over a few months, the scar tissue can shrink (contract) as part of the natural healing process. In some women, the capsule can become very tight. This is called capsular contracture. The reconstructed breast may then feel hard or painful. It may also change shape.

Smoking, infections or having radiotherapy to the chest increase the risk of capsular contracture.

Capsular contracture can be treated by taking fat from another part of your body and injecting it around the implant (lipomodelling). Or you may need an operation to remove the capsule or scar tissue and replace the implant. Some women may need to have the breast reconstructed with a flap of their own tissue.

Rippling of implants

The surgeon usually places the implant under the chest muscle. But the chest muscle is thin, so implants are close to the skin. If the implant is placed over the muscle, then the implant is also very close to the skin. This can make the implant crease, which can produce rippling. You may be able to see this all the time. Or you may only be able to see it when you move and the muscle contracts.

Your surgeon may suggest injecting fat under the skin (lipomodelling) to thicken the tissue over the implant. This can reduce the appearance of rippling. Lipomodelling may need to be repeated to get of the rippling completely.

Damage (rupture) to implants

It is very difficult to damage an implant. You should continue with your normal activities, including sports and air travel, without worrying that it will affect your implant. Implant rupture is now rare. Less than 1 in 20 women (5%) will have had an implant rupture within 10 years of having firm or solid gel implants.

But occasionally an implant might split or tear. Most silicone implants contain a firm gel. This is unlikely to leak in significant amounts, even if the outer cover is damaged. If this happens, it should not affect your health. But the implant will need to be replaced.

If saline leaks out of an expander device, it will not cause any harm. But the implant device will go flat and will need to be replaced.

Implants and mammograms

Implants can make mammograms (breast x-rays) more difficult to read.

If you have had a mastectomy, you will not need to have mammograms of the reconstructed breast. If you had an implant put into your natural breast you have regular mammograms of that breast. Women who have an implant put in after breast-conserving surgery still need mammograms.

It is important to tell the person doing the mammogram that you have an implant. This is so they can use the most appropriate screening method for you.

Safety and silicone breast implants

Quality control

A few years ago, there were concerns about the quality of the silicone used to fill breast implants. This happened because unapproved silicone was found in breast implants made in France by a company called Poly Implant Prostheses (PIP). PIP implants have not been used in the UK since 2010.

Breast implants used in the UK must 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. They will be able to tell you the type of implants they use and who makes them.

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)

Anaplastic large cell lymphoma (ALCL) is an extremely rare type of non-Hodgkin lymphoma that can sometimes affect the breast. Women with breast implants have an increased risk of developing ALCL in the tissue around an implant. This is called breast implant associated anaplastic large cell lymphoma (BIA-ALCL). The risk of this is extremely small with implants currently in use. The risk varies with the type of implant used. It is important to talk with your reconstructive surgeon before deciding on implant surgery.

If BIA-ALCL develops, it is most likely to show up as a swelling or an increase in the size of the breast. This can happen months or years after implant surgery. It can usually be successfully treated by an operation to remove the implant and the capsule of tissue surrounding it.

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