Breast Reconstruction Using Implants
Using a breast implant is one option to reconstruct the shape of your breast after surgery is done to remove the cancer. Several types of implants can be used. This type of breast reconstruction can be done in one step at the same time as the cancer surgery. Or it can be started when you have your cancer surgery and then completed during another surgery later on. 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 for breast reconstruction surgery. Implants are made of a flexible silicone outer shell, which can contain:
- Saline: These implants are filled with sterile (germ-free) salt water. These types of implants have been in use 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 is still possible.
Any type of implant might need to be replaced at some point if it leaks or ruptures. Concerns have been raised in the past about possible health issues from ruptured silicone-filled implants. But most recent studies show that silicone implants do not increase the risk of health problems, and they have been approved for use by the US Food and Drug Administration (FDA) since 2006.
Other types of implants that have different shells and are filled with different materials are being studied, but are only available by participating in clinical trials.
How are implant procedures done?
Breast reconstruction surgery using implants can be done in different ways:
One-stage immediate breast reconstruction (also called direct-to-implant reconstruction): The implant is put in at 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 is usually put beneath the muscle on your chest. A special type of graft (made from skin) or an absorbable mesh is used to hold the implant in place, much like a hammock or sling.
Two-stage reconstruction: For this type of reconstruction, a short-term tissue expander is put in 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. 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 to fill the expander over several months.
- In the other type, known as AeroForm®, the expander contains 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.
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. (Some expanders can be left in place as the final implant.)
This method is sometimes called delayed-immediate reconstruction because it allows time for other cancer treatment options. If radiation therapy is needed, the filling of the expander and the final placement of the implant is put off until radiation treatment is complete. If radiation is not needed, the surgeon can start right away with the tissue expander.
Tissue support when implants are used
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 to provide added skin coverage over the implant. See Breast Reconstruction Using Your Own Tissues (Flap Procedures) for more information.
Some products (such as AlloDerm® and DermaMatrix®) use donated human skin to support implants or transplanted tissues. These are known as acellular matrix products because they have had the human 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.
Doctors can also use synthetic mesh, animal skin with the cells removed (an acellular matrix such as Strattice™), and other methods for internal support.
The acellular matrix products are newer in breast reconstruction. 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.
Important things to think about
Keep these important factors 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 be reversible.
- MRIs may be needed every few years to make sure silicone gel implants have not broken. Your health insurance may 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.
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Last Medical Review: June 1, 2016 Last Revised: March 15, 2017
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