- Compared to tissue flap procedures, implant surgery is shorter, requires less skill and leaves fewer scars. Recovery is faster, but the whole reconstruction process takes longer to complete.
- There are downsides: It can be difficult to match your natural breast without additional surgery because implants cannot be shaped and moulded like living tissue. Your implanted breast will not droop or reflect weight changes like your opposite breast so you may become asymmetrical over time. Implants are devices which may need replacing over time. Breast implants are filled with saline (sterile saltwater) or silicone gel.
- Saline implants are filled just before they are used. The surgeon injects the solution directly into a valve on the top of the implant or via a tube that is removed once the implant reaches the desired size.
- Silicone implants are filled by the manufacturer.
- Breast tissue is removed as is some or all of the skin.
- Sometimes the nipple is kept.
- An implant is put under the muscle to replace the lost breast tissue.
- Used for women with early stage breast cancer or for women who have a high risk of developing breast cancer and want to have a breast removed to try and prevent cancer from developing.
- Reconstruction under the muscle is mostly suitable for women with fairly small breasts. It is not suitable for women who have had a radical mastectomy as the muscle will have been removed.
- Implants are not suitable if you are going to have/or have had radiotherapy to the breast, as the skin with not stretch enough.
- The scar may be one side of the nipple and continue sideways around it or run in the crease under the breast and/or may extend to the side of the breast.
Breast Expander – Using tissue expansion
- BR using tissue expansion can give pleasing results and avoids extreme surgery that using free flap involves.
- Some women find it frustrating because this method can take longer to form a breast.
- Tissue expansion uses the ability of your skin and muscle to stretch.
- Like implants, it is not suitable for women who have had, or are going to have, radiotherapy as the skin can lose its elasticity.
- One way of performing this procedure is by having two operations. Firstly, an expandable implant (like a deflated balloon) with a valve is put under the chest muscle and small amounts of saline are injected into the valve to make the ‘balloon’ expand. This is done on 1-2 week basis; despite a little pressure it is not too painful. The process continues until the breast is slightly larger than the other one. When the skin has stretched, a few months later, a second operation is performed where the fluid and inflatable bag are removed and a permanent, softer silicone implant is inserted. The previous increase in size allows the breast to be on the chest wall to create a more natural appearance.
- The second method is similar but uses an expandable silicone implant that stays there. The implant has an outer chamber of silicone gel and an inflatable inner chamber with an expansion valve. The inner chamber can be filled with saline to allow the implant to be adjusted for size. The implant is inflated over several weeks and left over-inflated for several more weeks to allow the skin to stretch. Some of the saline is then removed through the value so that is size matches the other breast. A small operation, carried out under local or general anaesthetic, is done to remove the valve.
- When the expander is being inflated it can be uncomfortable and the breast may feel tight and hard, but is should only last a couple of days. If this should be the case your doctor may remove a quantity of saline.
Possible Complications
- Infection – this ranges from a superficial wound infection, easily treated with antibiotics to an infection of the implant. Implant infections are especially troublesome as, generally, the implant must be removed to fully treat the infection, and only re-inserted several months after the infection is entirely resolved.
- Capsular Contracture – this is the commonest complication following implant reconstruction. A capsule is a normal reaction of the body to the foreign material and consists of a thin layer of fibrous tissue. Over the few months following the operation, this capsule shrinks as part of the normal healing process, but the extent of the shrinkage varies from person to person. In about 10% of women, it can become hard and contract against the implant, causing discomfort and a change in shape of the breast. Capsule contraction is more common after radiotherapy. If capsular contraction is a problem, the contracted capsule can be surgically removed to restore the breast shape.
- Bleeding – it is normal to have a small degree of oozing at the wound edges. It is possible that you may have a collection of blood (haematoma) under the skin, despite careful cautery to any bleeding points during the procedure. Haematoma after insertion of an implant increases the risk of capsular contracture and infection, so your surgeon may wish to take you back to theatre to remove the collection of blood
- Revision Surgery – as you breasts change over the years, following your reconstruction, the reconstructed breast will not age in the same way as your remaining natural breast and any asymmetry between the breasts is likely to increase. You may decide to undergo a balancing procedure at a later date to maintain the symmetry of your reconstruction.
- Recurrence – although this is not strictly a complication of the reconstruction, it should be mentioned that having a breast reconstruction must not interfere with treatment for the breast cancer and having a reconstruction would not stop a recurrence of the cancer, if it were to occur.