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Implant reconstruction uses a breast implant to replace the missing breast volume resulting from mastectomy. No matter which type of breast implant you choose for reconstruction, it is always placed beneath the pectoral chest muscle (unlike breast augmentation, which usually places the implant between the breast tissue and muscle).
Types of Breast Implants
The saline implant is the one most commonly used. It has an external silicone shell that is filled with sterile saline (salt water). Breasts reconstructed with saline implants tend to feel firmer than those reconstructed with silicone.
Silicone Gel Implants
Silicone implants are filled with liquid or cohesive gel silicone. They tend to be softer than saline implants and have a texture more like natural breast tissue.
To receive silicone implants for breast reconstruction, you must be a participant in a clinical trial approved by the Food and Drug Administration. Clinical trial availability varies by doctor and institution. At Fox Chase Cancer Center, we offer this option to women who are appropriate candidates for the procedure. If interested, you will receive information about the study and the safety of silicone during your office visit at Fox Chase.
Silicone implants are not used as often as in the past due to concerns that silicone leakage may cause debilitating immune system diseases. However, recent studies indicate they do not increase the risk of immune system problems. Silicone-gel implants also were thought to cause connective tissue disorder, but clear evidence of this has not been found.
Implant with Tissue Expander
In most cases, missing breast skin will need to be replaced after the mastectomy. To make room for your permanent breast implant(s), a tissue expander, or balloon-like device, may be used to stretch the skin and muscle on your chest wall. Reconstruction using an implant with tissue expander can take place immediately after mastectomy or you may opt for delayed reconstruction.
The Tissue Expansion Process
The tissue expander goes under the skin and pectoral muscle of your chest. This procedure takes about an hour followed by 3 days in the hospital. Your activities will be limited for 3 weeks after that to allow time to heal.
The tissue expander is then filled gradually with sterile normal saline to stretch the overlying skin and muscle. The expander is filled through a small needle that goes into a metal port built into the wall of the expander. The skin expansion usually occurs weekly on an outpatient basis over a period of about 2 months. It may be inconvenient, but is usually not painful and should not limit your activities.
Tissue Expander to Breast Implant
After the skin over the breast area has stretched enough, the expander is removed in a second operation. A permanent implant (either saline or silicone) is then put in its place. Your exchange from a tissue expander to a permanent implant will be scheduled 4 to 6 weeks after your last expansion. This same-day surgery takes about an hour for 1 breast; 1-2 hours for both breasts. You may return to your regular daily activities 2 weeks later. While some expanders are left in place as the final implant, they are not commonly used at Fox Chase.
AlloDerm for Tissue Expansion
A new technique, using a processed skin product called AlloDerm, allows the surgeon to make more room to replace missing breast volume at the time of mastectomy. It may be used along with a tissue expander. With AlloDerm, the expander can be filled with more saline initially. This decreases the number of visits the patient has to make to have her expander filled gradually.
Other important factors to consider about breast implants:
Implants usually will not last a lifetime, resulting in additional surgeries to exchange (replace) the implants. While sometimes implants "crinkle" (scallop and rippling) at the top, or can shift with time, many women don't find it bothersome enough to replace.
Local complications may occur with breast implants such as rupture, pain, capsular contracture (scar tissue around the implant), infection and/or a poor cosmetic result. This is very unusual, however, it can happen, so make sure to discuss it with your doctor.
Results of implant reconstruction are not as natural as with flap procedures. The cosmetic outcome is generally lower, but the surgical risk is also lower.
Because reconstruction with implants does not require removal of tissue from another part of the patient's body, the procedure does not result in scars at a flap donor site (unless an LD flap procedure is used).
Breast reconstruction is easier and simpler with implants than with your own tissue. Almost all plastic surgeons know how to do implant-based reconstruction.
All patients who have had breast reconstruction must visit their plastic surgeon each year for follow-up. For those with implants, capsular contracture and implant leaks tend to become more common with time and many will require additional surgery.
Implant-based reconstruction can be the best choice for patients who are not good candidates for longer, more complex operations or for whom the long-term advantages of flap procedures are less important. These patients may include women who are older, whose general health is impaired or who have a poor prognosis.
Symmetry with implants is easier to achieve if used for bilateral reconstruction (reconstruction of both breasts) because it does not involve matching the newly reconstructed breast to an opposite, natural breast. The symmetry achieved with bilateral implants is often maintained indefinitely because neither breast tends to develop much ptosis, or drooping.
In contrast, in most cases of unilateral implant reconstruction (reconstruction of one breast), the reconstructed breast droops less than the opposite, natural one. Therefore, it is often necessary to lift the opposite breast in a procedure called mastopexy. However, because the natural breast may droop with time, the symmetry created by mastopexy may be temporary. Implants also provide a better outcome for bilateral breast reconstruction because breast changes caused by capsular contracture frequently affect both breasts rather than only one.
Nipple and Areola Reconstruction
The decision to have your nipple and areola (the dark area around the nipple) reconstructed is up to you. Nipple and areola reconstructions are usually done as separate procedures after the new breast has had time to heal.
Tissue for the nipple is taken from your own body, such as from the newly created breast, opposite nipple or the ear. At Fox Chase, tattooing is done to create the areola and match its color to the pigment of the opposite breast.
Saving and using the nipple from the breast with cancer that has been removed is not a good idea. Cancer cells may still be hidden in the nipple.
For more information about breast cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427). The breast cancer scheduling department can be reached at 215-728-3001.
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