Implant reconstruction

An implant is a sac that’s filled with either silicone gel or a saltwater solution (saline). It is surgically inserted into the body to create a new breast shape.

There are benefits and drawbacks to having an implant – see the table below for more details. You need to discuss these with your surgeon. You may also find it helpful to talk with someone who has an implant – Cancer Council 13 11 20 or a breast care nurse may be able to put you in touch with someone.

Learn more about:


Types of implants

Silicone implants – These are used in almost all operations. A softer, honey-like type of gel was previously used, but implants are now made of a soft, semi-solid filling called cohesive gel. This gel is quite firm and holds its shape like jelly.

Some silicone implants are covered with a thin layer of polyurethane foam, which helps hold the implant in place. This can reduce the risk of the implant hardening or moving.

Saline implants – These are made of a solid silicone envelope filled with sterile saltwater (saline). They are no longer commonly used in reconstruction. Saline breast implants don’t look and feel as natural as silicone implants. A saline implant may gradually lose volume, deflate without warning or wear out. Skin wrinkling and “sloshing” may also occur.

For information on the safety of implants click here.


What to consider – implant reconstruction

Benefits

Drawbacks
  • Operation takes only a few hours and you usually only stay in hospital for a few days.
  • Creates the breast shape without moving tissue (muscle, skin or fat) from elsewhere in the body, so other parts of the body aren’t affected.
  • Only one scar from the mastectomy.
  • Recovery time at home is shorter than for a flap reconstruction. Although the chest area will be swollen and sensitive, you may be able to return to most activities within about a week.
  • Implants come in a range of shapes and sizes. You can choose to change your original breast size.
  • Doesn’t change in size if your weight changes.
  • Doesn’t cause issues, such as muscle weakness, that may occur as a result of a flap reconstruction.
  • Two or more operations may be required, if you have an expander first or if the expander is used as the implant. You will need regular doctor’s visits to gradually fill the expander. The whole process may take 3–6 months.
  • A breast reconstructed with a tissue expander and/or an implant usually feels firmer than a natural breast. While it won’t move like a natural breast, it usually looks the same (symmetrical) in a bra.
  • If your other breast changes in shape and size, you may need further surgery to match the two.
  • Hardened scar tissue (capsule) may form around the implant. This can distort the shape of the breast and cause pain in some circumstances.
  • Risk of infection, which may mean removing the implant.
  • Implants may need to be replaced after 10–15 years, but some can last for longer.

How an implant reconstruction is done

An implant reconstruction can be done in one operation or as a two-stage operation.

One-stage operation – This is used when there is enough skin to insert the implant under the chest muscle to replace the removed breast tissue. The operation is usually done at the same time as a skin- or nipple-sparing mastectomy. A dermal matrix or mesh is often used to cover part of the implant and this helps keep the implant in place.

Two-stage operation – In the first operation a balloon-like bag called an inflatable tissue expander is placed under the skin and chest muscle. The balloon is injected every couple of weeks with saline through a port that sits just under the skin. You may have 1–6 injections depending on how much the skin needs to stretch. The stretched tissue creates a pocket for the implant. After about six weeks, the temporary expander is removed and replaced with a permanent silicone or saline implant in a second operation. This procedure may require an overnight hospital stay.

woman with an implant reconstruction

Woman with an implant reconstruction

After the reconstruction you will have a scar on your breast.


Stages of delayed breast reconstruction with a tissue expander

Stages of delayed breast reconstruction with a tissue expander


Acellular dermal matrix

If there is not enough tissue to cover the entire implant other material called acellular dermal matrix (ADM) is used. This may be from animal (cow or pig) or human tissue. Sometimes synthetic material is used.

The ADM is processed and sterilised for use in surgery. It is cut to size and modelled to the shape of the breast. When in place, ADM works like building scaffolding – it is there to support and contain the breast implant. Your existing skin will grow into the ADM or the synthetic mesh as the area heals.


Risks of having an implant reconstruction

Before the operation, the surgeon will discuss the risks of an implant reconstruction with you. These may include:

Infection – You’ll be given antibiotics at the time of the operation to reduce the risk of infection. But if this happens, the implant usually has to be removed until the infection clears. The implant can then be replaced with a new one.

Implant rupture – Implants don’t last a lifetime. They can leak or break (rupture) because of gradual weakening of the silicone over time. According to the US Food and Drug Administration, about one in 10 of all silicone implants break or leak within 10 years of being implanted. The average implant lasts about 15 years. Usually, if an implant is known to have ruptured, it is replaced.

If a saline implant ruptures, salty water will leak into your body. The salty water is not harmful, but you will need to have surgery to remove the empty silicone envelope and replace the implant.

Hardening of the implant – A fibrous covering forms around a breast implant. If this hardens over time, it may make the reconstructed breast feel firm. This is called capsular contracture, and it is more common after radiotherapy. Capsular contracture can be uncomfortable or painful and may change the shape of the breast. Further surgery may be needed to remove and/or replace the implant.

Movement – The position of the implant in the body may change slightly over time. This is called implant displacement, descent or rotation. In a small number of cases, the implant shifts a lot and changes the shape of the breast. Further surgery can restore the implant to its original position.

Visible rippling – Sometimes implants adhere to the surface of the skin and this can affect how smooth the breast is.

Other health problems – There have been reports of a link between a rare type of lymphoma and breast implants. Since 2007, 53 cases of anaplastic large cell lymphoma (ALCL) have been diagnosed in Australia. The Therapeutic Goods Administration (TGA) recommends women monitor their breasts for any changes and have their implants checked regularly. If you are concerned, talk to your surgeon.

Research has not established a link between silicone breast implants and autoimmune disorders such as scleroderma, rheumatoid arthritis or lupus. There is also no evidence that implants cause breast cancer.

Read more risks of having an implant reconstruction

Staying informed about the safety of your implants

While implants are generally considered to be safe, there have been some concerns about risks.

Some silicone implants were voluntarily taken off the market in the 1990s due to safety concerns. Since then, regulatory authorities such as the Therapeutic Goods Administration (TGA) must approve brands used in Australia.

In April 2010, the French breast implant brand Poly Implant Prothèse (PIP) was withdrawn due to safety concerns and a possible increased likelihood of ruptures.

About 5000 Australians had a PIP implant between 2000 and 2010, but most of these were cosmetic procedures. Women worried about the safety of their implant should discuss any concerns with their surgeon.

The Australian Breast Device Registry (ABDR) is a national clinical quality registry for all people having breast implant surgery. The aim of the registry is to provide a way to track how the products perform and what the patient outcomes are after surgery. This can help identify early signs of problems with a device.

ABDR is supported by the Australian Society of Plastic Surgeons, Breast Surgeons of Australia & New Zealand and Australasian College of Cosmetic Surgery. Your surgeon will provide you with printed information about the registry and you’ll be contacted by ABDR after the surgery with more detailed information.

For more details on ABDR see abdr.org.au or ask your surgeon. You can also check tga.gov.au for safety alerts.


This information was last reviewed in June 2017
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