Breast reconstruction using implants

Implant surgery means using a silicone 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.

About breast implant surgery

This type of operation has the advantage of causing 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 feel colder. 

Even though silicone is safe, it is foreign to your body. Your body might form hardened tissue (a capsule) around the implant. In some women, over many years this may make the breast feel hard and uncomfortable and change its shape. This is called capsular contracture. So the breasts might gradually look uneven (asymmetrical). You might need surgery to change the implant or to the other breast to even them up.

People may need further surgery more often after implant breast reconstruction, than after living tissue reconstruction.

If you have an implant reconstruction after a mastectomy, you might need to have the skin stretched using a tissue expander implant first. Without stretching the skin, there might not be enough to make the breast shape.

Types of breast implant surgery

There are two main ways of doing implant surgery. The surgeon might put a permanent implant under the chest and muscle during the mastectomy operation. Or you might have a tissue expander implant inserted instead. 

You can find out more about tissue expander implants further down the page.

Immediate implant reconstruction

For this operation, your surgeon removes the breast tissue (mastectomy) but keeps the skin. They then replace the empty space with an implant. The implant creates a new breast shape. Your surgeon will try to match this to your other breast as much as possible, but it will not look the same.

Using a mesh to support the implant 

During the operation, your surgeon may also use a mesh called an acellular dermal matrix (ADM). This is made from pig skin or cow skin. Using pig or cow skin might not be acceptable to some women. Talk to your surgeon if this applies to you. The mesh can also be synthetic. This helps to keep the implant or tissue expander in place and create a natural droop.

Using a dermal sling to support the implant or tissue expander

In women with a large or droopy (ptotic) breast, the surgeon can reduce the size of the opposite breast and use some of the spare skin to cover and support the implant or tissue expander instead of using ADM.

During the operation, the spare skin in the lower part of the breast and part of the chest muscle are used to create a hammock like structure. This helps to support and keep the implant in place.

Tissue expander implant

A tissue expander is an empty implant that is gradually filled with salt water (saline) over time. The outer shell of the implant is made of silicone.

You usually have this with an immediate reconstruction. Its used less commonly for a  delayed reconstruction. 

With this type of reconstruction, the tissue expander slowly stretches your skin and chest muscles over a few 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. 

A tissue expander is used as a temporary implant. You have this exchanged with a silicone implant at a later stage. This is known as a two stage reconstruction. 

Sometimes a device which has a both a tissue expander and implant is used. This device has a silicone filled section at the front. At the back there is an empty compartment. This empty space can be filled with saline water in future through a removable tube and port. This type of tissue expander and implant device does not need to be exchanged. However, it’s still a two stage reconstruction. You have a short second operation to remove the port and tubing when you reach the right size.

How you have tissue expansion

For an immediate reconstruction, your surgeon removes the breast tissue and fits a tissue expander implant under the skin and muscles of your chest. If you have this as a delayed procedure the surgeon usually places the expander implant through the mastectomy scar. 

A couple of weeks after surgery when the scars have healed they inflate it a little at a time. They do this by putting sterile saline through a valve attached to the implant.

You go back to the 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 can take about 3 to 6 months.

Replacing the tissue expander

You have this operation to remove the tissue expander and the surgeon puts a silicone implant in its place. This operation takes about an hour. You might have this as a day case but some people may stay in hospital overnight. 

Possible side effects

Your breast might feel very tight and uncomfortable for 48 hours or so each time you have fluid added.

As time goes on, your new breast is likely to become less of a match for your remaining breast. The reconstructed breast might harden, and doesn't droop naturally with age.

Possible reasons for not having an implant reconstruction

This type of reconstruction is not always recommended if you are having radiotherapy to the area. Radiation increases the risk of the implant becoming hard and might distort the shape of the breast. It can also make the skin less stretchy. 

Your surgeon will talk to you about the options for reconstruction if you need radiotherapy. Sometimes the surgeon may suggest a two stage reconstruction. So you would first have the tissue expander. Then at a later date the tissue expander is exchanged for a silicone implant.

You can't have this type of reconstruction if you have had a radical mastectomy because the chest muscles will have been removed.

Are there risks with using implants?

Some people worry that implants could cause other illnesses. Surgeons in the UK follow strict safety standards when using implants. 

You can discuss which type of implant might be the best for you or whether you might prefer other types of reconstruction. 

Do talk to your surgeon if you have had breast implants and are worried.

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

BIA-ALCL is a rare type of lymphoma of the breast that can develop from textured breast implants. It generally develops slowly. Let your surgeon know if you have an area of swelling or notice any lumps in the breast or armpit.

This type of lymphoma is usually easy to treat with surgical removal of the lymphoma and the implant. Less commonly it can spread to the lymph node or other areas of the body. If you have this you will have radiotherapy and chemotherapy.

There are studies to find out more about this. In one study doctors want to understand more about how changes to certain genes, proteins, and sugars could affect how BIA-ALCL develops. This may help develop new treatments for this condition in the future.

Connective tissue diseases (breast implant illness)

In the past, there has been concern that implants filled with silicone gel could cause connective tissue diseases or autoimmune 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 might 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.

How long do silicone implant last?

The implant can remain in place for many years if there are no problems, but it's possible that you may need a replacement at some time. 

After breast reconstruction using implants

Arm and shoulder exercises

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. 

Recovery

It can take about 4 to 6 weeks to recover from implant reconstructive surgery. For some people, it may take longer. This depends on the type of surgery you have and if you have any problems after surgery.

Follow up

This will vary, your nurse will let you know how often you will need follow up appointments. 

You will still have regular mammograms on your other breast. You will not need one for the reconstructed breast unless you have some remaining breast tissue. Do ask your nurse if you are not sure. 

Surgery to the other breast

Your other breast is likely to change as you get older or if you gain or lose weight. You may need surgery to your natural breast to get a better match.