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, 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.

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. 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 by the US Food and Drug Administration for use since 2006.

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 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 under the muscle on your chest. A special type of graft (made from skin) or 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 the shape of a breast.

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 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. 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 allows time for other cancer treatment options. If radiation therapy is needed, the expander can be filled during other treatments (such as 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, 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.

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 may 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 surgeries (using other body tissues to create the new breast) are often delayed until after radiation

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

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 use donated human skin to support implants or transplanted tissues. These are known as acellular dermal 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 animal skin (usually from a pig) with the cells removed (an acellular matrix such as Strattice™ or Permacol™), 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.

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 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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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: July 1, 2017 Last Revised: September 12, 2017

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