Find out about surgery to have a new breast shape using an implant after mastectomy.
About breast implant surgery
Implant surgery means using a gel or salt water filled silicone balloon to recreate a breast shape after removal of a breast. It is the simplest way of making a new breast. One advantage is that it causes very little scarring. But the breast won’t feel as natural as it would if made with living tissue. It is likely to be firmer, less mobile and feels colder.
Even though silicone is safe, it is foreign to your body. Your body may form hardened tissue (a capsule) around the implant. In some women, over many years this may make the breast feel hard and uncomfortable and distort its shape (capsular contracture). So the breasts may gradually look asymmetrical and you may need surgery to even them up.
People need further surgery more often after implant breast reconstruction than after living tissue reconstruction.
If you have an implant reconstruction some time after a mastectomy, you may need to have tissue expansion as well. Without stretching the skin, there may not be enough to make the breast shape.
When you can't have this type of reconstruction
You can't have this type of reconstruction if you have had, or will have, radiotherapy to the area. Radiation increases the risk of capsular contracture and might distort the shape of the breast. It makes the skin less stretchy.
You can't have this type of reconstruction if you have had a radical mastectomy because the chest muscles will have been removed.
Types of breast implant surgery
There are two main ways of doing implant surgery. The surgeon might put the implant under the chest muscle during the mastectomy operation. But if you have the reconstruction some time after a mastectomy, you might need to have tissue expansion for a few months to stretch the skin.
Implant under your chest muscle
During the operation to remove your breast (a mastectomy), your surgeon can put in an implant under your chest muscles. They might need to use a specially processed pig skin called Strattice or processed cow tissue called SurgiMend. These are sheets of tissue called acellular dermal matrices (ADM). They create a layer to hold the breast implant firmly in place. Using pig skin or cow tissue may not be acceptable to women from some religious or ethnic groups.
In women with large breasts, the surgeon can reduce the size of the opposite breast and use some of the spare skin to cover the implant instead of using ADM.
Stretching the skin (tissue expansion)
With this type of reconstruction, an expander slowly stretches your skin and chest muscles over 2 to 3 months. Tissue expansion can be a good method of reconstruction if you have quite small breasts. It gives a good appearance and you don’t need to have a major operation.
You might not be able to have tissue expansion if you have large breasts or if you had radiotherapy to the area.
How you have tissue expansion
Your surgeon fits an inflatable balloon called a tissue expander under the skin and muscles of your chest. They inflate it a little at a time, by putting in sterile salt water (saline) through a valve in the bag.
You go back to hospital every couple of weeks to have more saline added. It usually takes 8 to 12 weeks to stretch the skin enough. The whole process takes about 3 to 6 months.
There are two ways of doing it:
- stretching the skin enough with fluid in the expander and then replacing it with a silicone implant
- leaving a silicone covered expander in place
The advantage to replacing the expander with a silicone implant is that the silicone gel implant has a more natural feel than the silicone covered fluid in the expander. But keeping the fluid filled expander means that you don't need to have a second operation.
If you are having the expander left in, your surgeon inflates it until it is slightly larger than your natural size. They leave it for 2 to 3 months. Then the surgeon deflates it to the right size. This gives your breast a natural droop. This type of implant has a silicone outer shell. It doesn't stretch the skin as much as other types of implant reconstruction and the appearance of the breast might not be as good.
If you are having the expander replaced, you have a second operation to remove the tissue expander. The surgeon puts a silicone implant in its place.
Both of these operations take about an hour. You will be in hospital for a day or two and should be fully recovered in two weeks.
Possible side effects
Your breast might feel very tight and uncomfortable for 48 hours or so each time you have fluid added. And as time goes on, your new breast is likely to become less of a match for your remaining breast. The reconstructed breast may harden, and doesn't droop naturally with age.
Breast implants and risks of other illnesses
In the past there has been concern that implants filled with silicone gel could cause connective tissue diseases or auto immune diseases. These are illnesses where something triggers the body's immune system to attack its own tissues. They include conditions such as arthritis and skin conditions and may cause muscle and joint pains.
Some women who have had implants filled with silicone gel have developed these illnesses. Some of the women feel strongly that the gel inside their implants leaked out and caused their illnesses.
A great deal of research has been done to check for a link between silicone and these connective tissue diseases. All the studies have shown that there are no more cases of connective tissue disease in women who have had silicone gel breast implants than in the general population. There is no evidence that silicone causes these illnesses.
In the UK, the Government has asked experts to review the evidence on this several times. Each of these reviews has found that there is no evidence of harm caused by silicone implants.
If you are worried
If you have had breast implants and are worried, you could talk to your surgeon about alternatives to implants filled with silicone. It may be possible for you to have an implant filled with salt water (saline) instead of silicone.
Saline implants have a silicone rubber envelope but silicone rubber has never been thought to be the cause of the connective tissue diseases.
You can discuss which type of implant might be the best for you with your surgeon. Many breast reconstruction surgeons think that silicone implants are better than saline for giving soft, natural results.
After breast reconstruction using implants
After the surgery, you will need to do some exercises to get your arm and shoulder moving properly again. Your nurse or physiotherapist will show you what to do and explain when to do the exercises.
While doing the exercises, it helps to wear a supportive and comfortable bra that is not under-wired. The types that have a front fastening are easier to get on and off. If you have any swelling, you may need a slightly larger size than usual for a short time. Your bra can often help to support and mould the reconstruction. Your surgeon or breast cancer nurse can advise you about this.