Breast Reconstruction Using Implants

Using a breast implant is one option for reconstructing the shape of your breast after surgery to remove the cancer. Several types of implants can be used. This type of breast reconstruction can be done at the same time as the cancer surgery. Or it can be started when you have your cancer surgery and then completed later. You should understand the benefits and risks of implants for breast reconstruction and discuss them with your doctor. 

What types of implants are used for breast reconstruction?

Several different types of breast implants can be used to rebuild the breast. Implants are made of a flexible silicone outer shell, and can contain:

  • Saline: These implants are filled with sterile (germ-free) salt water. These types of implants have been used the longest.
  • Silicone gel: Gel implants tend to feel a bit more like natural breast tissue. Cohesive gel implants are a newer, thicker type of silicone implant. The thickest ones are sometimes called “gummy bear” implants. They are more accurately called form-stable implants, meaning that they keep their shape even if the shell is cut or broken. They are firmer than regular implants and might be less likely to rupture (break), although this still might happen.

There are different shapes and sizes of saline and silicone implants and they can have either smooth or textured (rough) surfaces. Any type of implant might need to be replaced at some point if it leaks or ruptures. In the past, there were concerns about possible health issues from ruptured silicone-filled implants, such as connective tissue disease, breast cancer, or reproductive problems. But so far, studies show that silicone implants do not increase the risk of these health problems. Some people with breast implants may have symptoms of joint pain, memory loss, or fatigue. It is not clear if these symptoms are related to the breast implants and more research is being done.

There does appear to be a link between breast implants with textured surfaces and a type of cancer called anaplastic large cell lymphoma (ALCL). This breast implant-associated lymphoma is discussed more below.

Other types of implants that have different shells and are filled with different materials are being studied, but are only available if you are participating in a clinical trial.

How are implant procedures done?

You might have a choice between having breast reconstruction at the same time as the surgery to treat the cancer (immediate reconstruction) or later (delayed reconstruction). 

Immediate breast reconstruction (also called direct-to-implant reconstruction) is done, or at least started, at the same time as surgery to treat the cancer. The implant is put in the same time as the mastectomy is done. After the surgeon removes the breast tissue, a plastic surgeon puts in a breast implant. The implant can be put under the skin or muscle on your chest. An absorbable mesh is sometimes used to hold the implant in place, much like a hammock or sling.

The benefit of immediate reconstruction is that breast skin is often preserved, which can produce better-looking results. Women also do not have to go without a breast shape.

While the first step in reconstruction is often the major one, many steps are often needed later to get the final shape or appearance. If you’re planning to have immediate reconstruction, be sure to ask what will need to be done afterward and how long it will take.

Delayed breast reconstruction means that rebuilding is started later, after the cancer surgery is done. For this type of reconstruction, a short-term tissue expander is placed during the mastectomy to help prepare for reconstructive surgery later. The expander is a balloon-like sac that starts off flat and is slowly expanded to the desired size to allow the skin to stretch. Once the skin over the breast area has stretched enough, a second surgery is done to remove the expander and put in the permanent implant.

This method allows time for other cancer treatment options to be given. For example, the expander can be filled during chemotherapy, but the final placement of the implant is put off until radiation treatment is complete. If radiation is not part of the treatment plan, the surgeon can start filling the tissue expander after surgery.

Two types of expanders are available:

  • In one type, the surgeon injects a salt-water solution through a tiny valve under the skin at regular intervals (every 1, 2, or 3 weeks) to fill the expander over several months.
  • In the other type, the expander uses compressed carbon dioxide gas. The patient uses a remote control to release small amounts of the gas into the expander several times a day over 2 to 3 weeks.

You might choose to delay breast reconstruction if:

  • You don’t want to think about reconstruction while coping with the cancer treatment. If this is the case, you might choose to wait until after your breast cancer surgery to decide about reconstruction.
  • You have other health problems. Your surgeon might suggest you wait for one reason or another, especially if you smoke or have other health problems. It’s best to quit smoking at least 2 months before reconstructive surgery to allow for better healing.
  • You need radiation therapy. Many doctors recommend that women not have immediate reconstruction if they will need radiation treatments after surgery. Radiation can cause problems after surgery such as delayed healing and scarring, and can lower the chances of success. Flap reconstruction surgery (using other body tissues to create the new breast) is often delayed until after radiation.

Your surgical team will discuss your best reconstruction options, taking into account your medical history, body shape, cancer treatment and personal goals.

Tissue support for implants

Tissue support is sometimes needed for breast reconstruction, especially when implants are used. This tissue can provide added coverage over the implant, hold the implant in place, or position the muscle where it needs to be.

One way to do this is to use a woman’s own body tissues as part of a flap procedure. Tissue from another part of the body, such as the tummy or back, is used to create a kind of pocket to hold the implant in place or for added skin coverage over the implant. See Breast Reconstruction Using Your Own Tissues (Flap Procedures) for more information.

Some products use donated human skin or pig skin to support implants or transplanted tissues. These are known as acellular dermal matrix products because they have had the human or pig cells removed. This reduces any risk that they carry diseases or that the body will reject them. They are used to extend and support natural tissues and help them grow and heal.

The use of acellular matrix products in breast surgery first started in the early 2000s. Studies that look at outcomes are still being done, but they have been promising overall. This type of tissue is not used by every plastic surgeon, but it is becoming more widely available. Talk with your doctor about whether these materials will be used in your reconstruction and about their benefits and risks.

Risks of breast implants

Certain types of breast implants can be linked to a rare kind of cancer, known as anaplastic large cell lymphoma (ALCL). It is sometimes referred to as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It is not a type of breast cancer. This lymphoma happens around 8 to 10 years after the implant was placed and more often if the implants have textured (rough) surfaces rather than smooth surfaces.  If BIA-ALCL does show up after an implant, it can show as a collection of fluid near the implant, a lump, pain, swelling or asymmetry (uneven breasts). If you have any concerning symptoms, you should discuss them with your doctor.

Early-stage disease is often treated with surgery to remove the implant and capsule. More advanced disease requires chemotherapy. Radiation may be used in certain cases. Prognosis (outcomes) is usually better for women with early-stage disease.

Things to think about before getting implants

Most women will do well with implants. But there are some important factors to keep in mind if you are thinking about having implants to reconstruct the breast and/or to make the other breast match the reconstructed one:

  • You may need more surgery to remove and/or replace your implant later. In fact, up to half of implants used for breast reconstruction have to be removed, modified, or replaced within 10 years.
  • You might have problems with breast implants. They can break (rupture) or cause infection or pain. Scar tissue may form around the implant (called capsular contracture), which can make the breast harden or change shape, so that it no longer looks or feels like it did just after surgery. Most of these problems can be fixed with surgery, but others might not.
  • Breast MRIs may be needed every few years to make sure silicone gel implants have not broken. Your health insurance might not cover this.
  • Routine mammograms to check your remaining breast for cancer could be harder if you have a breast implant there – you may need more x-rays of the breast, and the compression may be more uncomfortable.
  • An implant in the remaining breast could affect your ability to breastfeed, either by reducing the amount of milk or stopping your body from making milk. 

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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Last Medical Review: September 18, 2019 Last Revised: September 18, 2019

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