1. What is breast reconstruction using an implant?
This type of breast reconstruction uses a breast implant to restore the shape and volume of the breast after a mastectomy.
Most breast implants are made of silicone, though some contain a combination of silicone and salt water (saline).
Most breast implants are expected to last between 10 and 20 years and will probably need replacing at some point. However, you do not need to have your implant replaced unless you are having problems with it.
2. Who might be offered it?
You may be offered an implant reconstruction if you do not have enough tissue elsewhere on your body to create a breast shape.
You may be offered a choice between having an implant or reconstruction using your own tissue.
Having an implant usually involves a shorter operation than other types of reconstruction. It may be suitable for people with existing health conditions that would prevent them from having a longer operation.
3. How reconstruction using an implant will look and feel
Breast implants are round or teardrop shaped and can often provide a close match to a natural breast shape.
The breast will be firmer and move less naturally than when your own tissue is used for reconstruction.
The reconstructed breast can also feel colder and heavier than your natural breast.
It will not droop with age and may look higher than the other breast, particularly as you get older.
If you lose or gain weight, this will affect the natural breast but not the reconstructed breast, causing a difference in shape and size.
At some point you may need more surgery to the reconstructed breast, or to the other breast, for a better match.
4. Types of breast implant
There are 2 types of breast implant.
Fixed-volume implant
A fixed-volume implant has a silicone outer shell and is usually filled with silicone.
Using a fixed-volume implant alone is the simplest type of reconstruction operation.
The recovery time is usually quicker than for other types of reconstruction.
Tissue expander implant
An expander implant is an empty implant or one that’s partly filled with silicone, which has a silicone outer lining.
After surgery, the implant is gradually filled or "inflated" over time using salt water (saline).
The saline solution is injected into a valve (port) just under the skin, usually every 1 or 2 weeks though timing may vary. This is to slowly stretch the skin over time.
The port may be on the surface of the implant or connected to the implant with a small tube (remote). If you have an implant with a remote port, you may be able to feel the port under the skin along the bra line.
This type of reconstruction is often considered if you do not have enough skin left on your chest to comfortably cover and support an implant, especially if you’re having delayed reconstruction.
A tissue expander implant may also be considered when you have a skin-sparing mastectomy and your treatment team may be worried about wound healing.
It may not be suitable if you have had radiotherapy. This is because radiotherapy reduces the elasticity and quality of the skin.
Tissue expander implants can sometimes feel heavier, firmer and less natural than fixed-volume silicone implants.
5. How implant reconstruction is done
Immediate reconstruction using an implant
Immediate reconstruction using an implant can be done as a single or 2-stage procedure.
Single procedure
A fixed-volume silicone implant is inserted in front of or under the chest muscle at the same time as your mastectomy.
2-stage procedure
Some women have a temporary tissue expander implant which is expanded over time and later replaced with a fixed-volume silicone implant.
This might also be referred to as a delayed-immediate reconstruction.
Delayed reconstruction using an implant
A tissue expander implant is placed either in front of or behind the chest muscle, usually through the mastectomy scar.
The expander is gradually inflated over time using saline.
Once it has been fully inflated, the expander implant may be left in place or it may be replaced with a fixed-volume silicone implant.
Supporting the breast implant
Using a surgical mesh
A surgical mesh can be used during breast reconstruction to support the breast implant. It’s attached to the chest muscle to create a pocket that holds the implant in place. This helps create a natural droop, shape and contour.
ADM (acellular dermal matrix) is a type of mesh made from animal tissue, usually pig or cow skin.
If you don’t want your surgeon to use products made from animal skin, talk to them about possible synthetic alternatives.
An ADM or synthetic mesh may be more suitable for women with small or medium-sized breasts.
Not all implants need a mesh to support them.
Using your own tissue
If you have larger, more droopy breasts, your surgeon may consider using your own tissue from the lower half of the breast to support the implant. This procedure is known as a dermal sling. Having this type of surgery is likely to reduce your breast size. You may need further surgery to the other breast, either at the same time or in the future, to get a better match.
Placement of implants
Implant under the chest muscle
Inserting the implant under the chest muscle helps to keep the implant in the right place and hide its outline.
A surgical mesh is attached to the chest muscle and used to cover the lower part of the implant. This can give a more natural appearance and avoid overstretching the chest muscle.
Sometimes after surgery the chest wall muscle can contract, causing the breast implant and overlying skin to move. This is known as breast animation deformity. It can sometimes be visible within the cleavage area of the breast and may cause discomfort.
Implant in front of the chest muscle
Placing the implant in front of the chest muscle is a newer technique and may not be suitable for everyone.
A surgical mesh stitched to the chest muscle covers the implant and provides support. This helps improve the appearance of the reconstructed breast and creates a natural droop.
6. Are breast implants safe?
Implants used in the UK meet specific safety standards and surgeons continue to recommend them to women considering breast reconstruction.
Breast implant-associated illnesses
Two very rare types of cancer have been found in a very small number of women with breast implants. These are called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-associated squamous cell carcinoma (BIA-SCC).
The most common symptom for BIA-ALCL and BIA-SCC is a swelling around the implant and breast.
If you develop a lump or a swelling around your implant, regardless of how many years later, contact your GP or treatment team so you can get your symptoms checked out.
In most cases BIA-ALCL and BIA-SCC can be treated successfully by removing the implant.
If you’re considering having implants, your treatment team will talk to you about the risks of BIA-ALCL and BIA-SCC.
Breast and Cosmetic Implant Registry (BCIR)
If you have breast reconstruction using an implant, you’ll be asked to have this recorded on a national registry.
This is so your details can be easily found if implants ever need to be recalled or removed.
Talk to your surgeon or treatment team if you’d like to know more about this.
Your surgeon should give you information about your breast implant such as the manufacturer, serial number and type of implant.
