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Breast reconstruction using implants

Two main types of implant are available. They are both made of a silicone rubber envelope. One type is filled with silica gel and the other with sterile salt water (saline).

Implant surgery is the simplest way of making a new breast. One advantage is that it causes very little scarring. There is also only one scar because tissue is not taken from another part of the body. But the breast won’t feel as natural as it would if made with living tissue. 

Even though silicone is safe, the implant is a foreign body and your own body may form a capsule around it. In some women, over many years, this may make the breast feel hard and uncomfortable and distort its shape. So further surgery may be needed. This is more likely with implant surgery than with body tissue reconstruction.

There are two ways to have implant surgery. Neither type is suitable for everyone. You may be able to have an implant put in under your chest muscles at the time of your cancer surgery. Or you can have a tissue expansion. With tissue expansion reconstruction your skin and chest muscles are slowly stretched and then the surgeon puts an implant of the right size underneath.

Breast implants and risk of other diseases

Researchers have looked at whether implants filled with silica gel could cause connective tissue diseases or autoimmune diseases. But many studies have shown that there are no more cases of these diseases in women who have had silica gel breast implants than in the general population. So there is no evidence that silicone is the cause of these illnesses in women who have had implants.

 

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What implants are

Two main types of implant are available. They are both made of a silicone rubber envelope. One is filled with silicone gel and the other with sterile salt water (saline). There have been other types of implants, but none of these are approved by the Department of Health because there isn’t enough information available about their long term safety. If you are worried about the safety of silicone implants there is information further down this page.

 

About breast implant surgery

Implant surgery is the simplest way of making a new breast. One advantage is that it causes very little scarring. The downside is that the breast won’t feel as natural as it would if made with living tissue. It is likely to be firmer, less mobile and feel colder. 

Even though silicone is safe, you are introducing a foreign body and there is a tendency for your own body to form a capsule around it. In some women, over many years this may make the breast feel hard and uncomfortable and distort its shape (known as capsular contracture). So the breasts may gradually get out of alignment and may need surgery to even them up after some time. Further surgery is needed more often after implant breast reconstruction than after living tissue reconstruction.

There is more about possible problems with reconstruction in this section.

 

Implants under your chest muscle

During the operation to remove a breast (a mastectomy) your surgeon can put in an implant under your chest muscles. They may 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. 

If you have implant reconstruction done 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. You cannot have this type of reconstruction if you have had, or will have, radiotherapy to the area after your surgery. Radiation increases the risk of capsular contracture and may distort of the shape of the breast.

You cannot have this type of reconstruction if you have had a radical mastectomy and so the chest muscles have been removed.

After the surgery, the reconstructed breast usually looks quite good because the surgeon uses your normal breast skin to make the new breast. As time goes on, the reconstructed breast is likely to harden and may rise higher but your own remaining breast is likely to droop more. So you may need surgery to your remaining breast so that they match again.

 

Stretching the skin (tissue expansion)

With this type of reconstruction, your skin and chest muscles are slowly stretched over 2 to 3 months. Then your surgeon puts an implant of the right size underneath. 

You may not be able to have tissue expansion if you have

  • Large breasts
  • Had radiotherapy to the area (as your skin will be less stretchy)
  • Had a radical mastectomy (had your chest muscles removed)

The whole process takes about 3 to 6 months. There are two ways of doing it

  • A bag of fluid is put in, filled with fluid, and later replaced with a silicone implant
  • A bag of fluid is put in and left there

The advantage to having the expander replaced is that silicone has a more natural feel than the fluid.

When you have your operation, the surgeon fits an inflatable bag called a tissue expander under the skin and muscles of your chest. The surgeon inflates this 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.

Diagram of an inflatable breast implant

If you are having the expander left in, your surgeon will inflate 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. If you are having the expander replaced with a silicone implant, you have a second operation to remove the tissue expander and put the implant in its place. 

One type of implant is made of silicone and has an expander inside it. You don’t need to have this one replaced once it has been expanded to the right size. But this type of implant does not stretch the skin so much and the appearance of the breast may not be as good as after other types of implant reconstruction.

Both of the above operations take about an hour. You will be in hospital for a day or two and should be fully recovered in two weeks.

Tissue expansion can be a good method of reconstruction if you have quite small breasts. It gives reasonable results and you don’t need to have a major operation. But expanding the implant takes a few months. Your breast may 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 does not droop naturally with age.

Diagram of a breast implant

 

Breast implants and risk 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 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 instead of silicone. These saline implants still have a silicone rubber envelope but silicone rubber has never been thought to be the cause of the connective tissue diseases. It is the silicone gel inside the implants that has been blamed as a possible cause of illness. This is something you need to discuss with your reconstruction surgeon. Many breast reconstruction surgeons think that saline implants are not as good as silicone 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 with show you what to do and explain when to do the exercises. There is information about exercises after implant reconstruction on the next page.

While doing the exercises it helps to wear a supportive and comfortable bra that is not under wired. They 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 and your surgeon or breast cancer nurse can advise you on this. 

 

More information about breast implants

If you would like to have detailed information about the different types of breast implant you can find it on the Medical and Health Regulatory Authority website.

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Updated: 31 July 2014