Using an implant to rebuild the breast requires less surgery than flap reconstruction, since it only involves the chest area (and not a tissue donor site). Still, it may require more than one procedure as well as a series of outpatient visits over a period of months to fill the expander. You may also require additional surgery in the future, as implants can wear out and develop other issues, such as tightness of scar tissue around the implant.
Breast implants are made of a silicone outer cover and can be filled with saline (salt water) or, more usually, silicone gel. They come in teardrop or round shapes and in different sizes. One of these shapes may be a better match for the contour of your breast area. The surface of the implant may be smooth or have a slightly rough texture - but you won’t feel this through your skin. However, you’ll likely be able to feel wrinkles and the texture of the implant when you rub your hand over the breast, particularly the lower part. Your plastic surgeon may prefer one type of implant over another for technical reasons. In some cases, implants with a slightly rough texture may help lower the risk of scar tissue forming around the implant.
Breast implants are made of a silicone outer cover and can be filled with saline (salt water) or, more usually, silicone gel. They come in teardrop or round shapes and in different sizes. One of these shapes may be a better match for the contour of your breast area. The surface of the implant may be smooth or have a slightly rough texture - but you won’t feel this through your skin. However, you’ll likely be able to feel wrinkles and the texture of the implant when you rub your hand over the breast, particularly the lower part. Your plastic surgeon may prefer one type of implant over another for technical reasons. In some cases, implants with a slightly rough texture may help lower the risk of scar tissue forming around the implant.
What options are available?
Implants are often used to reconstruct a breast following mastectomy. There are 2 types of breast reconstruction options using implants only:
OPTION 1. TRADITIONAL TISSUE EXPANDER IMPLANT (Two stage):
This is a very common technique of breast reconstruction, and is most often performed in two stages. This reconstruction is suitable for women wanting immediate reconstruction after a mastectomy, or it can also be performed some months after your mastectomy (delayed reconstruction).
In the first stage of this procedure, a tissue expander is inserted into a pocket created under your skin and chest muscle. The tissue expander is a silicone balloon filled with saline (sterile salt water). The expander is partially inflated with saline after insertion whilst you are asleep. Following the initial operation and over a period of weeks to months, a valve in the expander allows the surgeon or nurse to inject further saline solution and gradually fill the expander to help stretch the muscle and skin to the breast size desired. After the skin over the breast has been fully stretched to achieve the desired size and allow for placement of the permanent implant, a second operation is undertaken to exchange the tissue expander for a permanent implant.
OPTION 1. TRADITIONAL TISSUE EXPANDER IMPLANT (Two stage):
This is a very common technique of breast reconstruction, and is most often performed in two stages. This reconstruction is suitable for women wanting immediate reconstruction after a mastectomy, or it can also be performed some months after your mastectomy (delayed reconstruction).
In the first stage of this procedure, a tissue expander is inserted into a pocket created under your skin and chest muscle. The tissue expander is a silicone balloon filled with saline (sterile salt water). The expander is partially inflated with saline after insertion whilst you are asleep. Following the initial operation and over a period of weeks to months, a valve in the expander allows the surgeon or nurse to inject further saline solution and gradually fill the expander to help stretch the muscle and skin to the breast size desired. After the skin over the breast has been fully stretched to achieve the desired size and allow for placement of the permanent implant, a second operation is undertaken to exchange the tissue expander for a permanent implant.
How is the TRADITIONAL Tissue Expander Implant operation performed?
During an immediate breast reconstruction, your plastic surgeon places a tissue expander between the skin and chest muscle after your breast surgeon has removed the breast tissue. A tissue expander is an implant that’s more like a balloon. It stretches the skin to make room for the final implant. The expander has a valve that allows the surgeon to add increasing amounts of saline (a salt water solution) over time (between 2 to 6 months) until the skin gradually is stretched enough to accommodate the implant. If you're having implant surgery some time after mastectomy and other treatments (delayed reconstruction), surgery to insert the tissue expander may be done about 4 to 6 months after your last treatment. If many months or years have passed since your mastectomy, it still may be possible to have tissue expansion and implant reconstruction. It really depends upon the condition of the skin at the surgery site (for example, how much skin is left and how much scarring there is). To stretch the skin, over the course of a few months you will receive a series of saline injections into the tissue expander. After each injection, you might feel some pain or pressure for a few hours. This usually goes away by the next day. Once the skin stretching is completed, you'll most likely have more surgery to replace the tissue expander with a permanent implant. Surgery is usually scheduled about 4 to 6 weeks after the last amount of liquid has been added to the expander. Surgery to insert the permanent implant takes about an hour. |
Who is a good candidate for Tissue Expander Implant Surgery?
You are an ideal candidate for this procedure if you:
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How long is this surgery?
About on hour for the reconstruction.
How many nights in hospital are needed to recover?
If you have had a mastectomy, as well as reconstruction, expect to stay in hospital for around 3 nights, otherwise 1 night per stage.
Saline or gel breast implants, are available in a wide range of shape, sizes and profiles to fit your body.
OPTION 2. DIRECT TO IMPLANT (One stage)
This is a newer technique that is not yet widely available in Australia, although there are now a few surgeons able to offer this option. This procedure is suitable for selected women who have had skin-sparing mastectomies and are seeking immediate reconstruction. This technique aims to provide one-step surgery through the use of a specialised surgical mesh (called Acellular Dermal Matrix, ADM) to create a sling within the chest that cradles the implant, which is inserted at the same time. ADM is a tissue-like substance made from human tissue or pig skin that has been specially treated and has been approved for use in this type of procedure. As the surgeon can manipulate the implant position within the sling the result is a more natural looking breast.
Direct to implant reconstruction can only be performed if you want to stay the same size or go smaller. You cannot have a large implant, ie over 400cc if you are considering a 1 stage reconstruction.
While this procedure aims to provide a new breast shape in one step, sometimes tissue expansion is still needed.
This is a newer technique that is not yet widely available in Australia, although there are now a few surgeons able to offer this option. This procedure is suitable for selected women who have had skin-sparing mastectomies and are seeking immediate reconstruction. This technique aims to provide one-step surgery through the use of a specialised surgical mesh (called Acellular Dermal Matrix, ADM) to create a sling within the chest that cradles the implant, which is inserted at the same time. ADM is a tissue-like substance made from human tissue or pig skin that has been specially treated and has been approved for use in this type of procedure. As the surgeon can manipulate the implant position within the sling the result is a more natural looking breast.
Direct to implant reconstruction can only be performed if you want to stay the same size or go smaller. You cannot have a large implant, ie over 400cc if you are considering a 1 stage reconstruction.
While this procedure aims to provide a new breast shape in one step, sometimes tissue expansion is still needed.
How is the Direct to Implant (One-Step) operation performed?
This technique is performed immediately following the removal of the breast. A special surgical mesh (ADM) is attached to the pectoralis muscle in the chest making a “sling” in which a permanent implant can be placed. This sling allows for an extension of the pectoralis muscle to the chest wall, therefore providing more soft tissue coverage for the implant. It also holds the lower part of the implant in place and helps to give the breast a natural droop.This procedure provides you with immediate results as you will wake to have definitive breast volume and approximate shape. Depending on the quality of the result after allowing the initial reconstruction to settle and heal for a few months, a second stage reconstruction creating a more refined breast shape may still be desirable. This is an outpatient procedure that involves minor refinements in contour and symmetry potentially without exchanging the implant. |
Who is a good candidate for Direct to Implant (One-Step) surgery?
This procedure is suited to women who have enough quality breast skin left over after mastectomy (e.g. nipple-sparing mastectomy) to ensure that the skin can accommodate the new implant. This option may be especially beneficial to younger women carrying out bilateral prophylactic mastectomies. You are an ideal candidate for direct to implant post mastectomy reconstruction if you:
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How long is this surgery?
The initial implant placement, and possible second stage, each take about one hour.
How many nights in hospital are needed to recover?
If you have had a mastectomy, as well as reconstruction, expect to stay in hospital around 3 nights, otherwise 1 night per stage.
AdvantagesHaving an implant put into the breast is a shorter, less complex operation and recovery time is quicker than any other types of reconstruction. An implant reconstruction also;
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DisadvantagesWhile the initial surgery and recovery may be quicker than other types of reconstruction, the overall reconstruction process can take longer (with multiple steps, including multiple office visits to receive tissue expander injections and replacing the expander with a permanent implant). In addition;
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Post Operative Care for Implant Reconstruction
You'll be moved to the recovery room after surgery, where hospital staff members will monitor your heart rate, body temperature, and blood pressure. If you're in pain or feel nauseated from the anesthesia, tell someone so you can be given medication.
You'll then be admitted to a hospital room. The morning after your surgery, your surgeon, nurse or physiotherapy staff will show you an exercise routine you can do to prevent arm and shoulder stiffness on the side where you had the mastectomy and to help prevent the formation of significant scar tissue. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises. On leaving the hospital, your surgeon will give you specific instructions on post-operative care, including; caring for your new breast/s, medications to use, symptoms or concerns to look out for during the recovery period and when follow up is required. |
What is the expected recovery time?
If reconstruction is done at the same time as your mastectomy it can take up to 6 weeks to recover. Otherwise, for delayed reconstructions, recovery can take 2-3 weeks before you can resume normal activities.
What are the risks?
After any operation, there is a risk of problems immediately afterwards, such as bleeding, pain, infection and bruising. Most women don’t have many problems, but possible problems include the following.
Infection
It’s uncommon to have an infection in the tissue around the implant. 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. You’ll be given antibiotics at the time of your operation to reduce the risk of infection. If an implant needs to be removed due to infection, the final appearance of the reconstructed breast may not be as good. Tightening or hardening of tissue around the implant (capsular contracture) Over a few months, the scar tissue shrinks (contracts) as part of the natural healing process. In a few women, the capsule can become very tight. This is called capsular contracture. If it happens, your breast may feel hard, painful or change shape. Sometimes an operation is needed to remove the implant and replace it with a new one. This process can take months or years, commonly 10-15years or in some patients never at all. This is the most common reason you are told that implants need changing every 10-15 years. Post-operative exercises and massage can reduce the risk of contracture. Haematoma, infection and radiotherapy increase the risk of capsular contracture. Shifting, leaking (rupture) to implants There's a small risk that your implant might shift slightly over time. If that happens, you may be able to massage it back into place. If your implant shifts a lot, schedule an appointment with your plastic surgeon to discuss ways to stop the problem. In some cases, your surgeon may have to build a reinforced pocket in your chest to hold the implant in place. This pocket is made from your own tissue and a dermal matrix product, if needed. All implants have a slight risk of rupturing. The chance of your implant rupturing increases over time. Most implants that have been in place for 10 to 20 years have some leakage, thus the potential need for replacing the implant at this time. |
Pain around implant
Some women feel pain or discomfort from the tissue expander, the implant, or scar tissue putting pressure on a nerve or other sensitive area. Your doctor may prescribe a program of exercise, stretching, and massage, and possibly anti-inflammatory medicines, to relieve mild pain. Acupuncture, breathing exercises, yoga, and meditation also can help. If you have pain that is intense, your doctor may recommend physical therapy, seeing a pain specialist, or stronger medicines. Distortion with movement A breast reconstructed with an implant may move in unnatural ways as you flex your chest muscle (pectoralis muscle). Because the skin tends to scar down to the underlying muscle, any movement may cause distortion in the shape of the breast. Although this isn’t dangerous, some women find it uncomfortable or distressing -- especially if it wasn’t discussed as a possibility before surgery. Tissue breakdown Sometimes the tissue in the breast area doesn't heal properly because of pressure from the implant or expander. The network of vessels that supply blood to the tissue could have been slightly damaged during surgery or radiation. Smoking and diabetes also can damage the small blood vessels that supply blood to the tissue and promote healing. Doctors call this tissue breakdown “necrosis.” Some symptoms of tissue necrosis include pain and bleeding, the skin turning dark blue or black, numbness, and sores that ooze a bad-smelling discharge or pus. You also may run a fever or feel sick. If tissue breakdown happens, the dead tissue will need to be removed and the open area has to be closed, either by re-growth of your own tissue or by using a dermal matrix product. In some cases, your surgeon may recommend a skin or tissue graft (taking skin or tissue from another place on your body) to cover or fill in the affected area. There is also a high risk that the implant will have to be removed as a result of contamination. |
Australian Breast Device RegistryThe ABDR is a national clinical quality register for high risk implantable breast devices; implants and tissue expanders. It provides a tracking system for breast devices and a structure for monitoring device performance and patient outcomes following breast surgery.
Read more here - Breast implant cancer link supports need for extended device monitoring
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Recovery advice
Your surgeon will provide you with advice on caring for your new breast, when you can shower or bathe, as well as how to look after any drains that are still in place. Drainage tubes remove fluids that collect in the surgical site. The drainage tubes remain in place until the amount of fluid draining substantially decreases.
If you have had a tissue expander inserted, you will need to see your doctor regularly over several weeks or months to have the expander filled until the desired shape and size have been achieved for the implant. A support bra may be worn to help reduce swelling and support the reconstructed breast.
You may be prescribed painkillers, antibiotics and anti-inflammatory drugs when you are first discharged from hospital. It is vital to use these as prescribed to successfully manage any pain and to reduce the risk of infection.
Post-operative recovery can take longer if complications occur, so it is important to get adequate rest, make sure you follow your surgeon’s directions and exercise within the limits of comfort – if you feel any pain or pulling, especially around the wound sites, stop. It is normal to feel tired and sore after your surgery. Generally it is advised not to swim, play sports, exercise or do any heavy lifting for at least two weeks after your surgery. There is no set rule when it comes to your recovery time. Your Specialist Plastic Surgeon will prepare detailed instructions on post-operative care – make sure you follow these carefully.
It can take up to twelve months to completely heal and for scars to fade and for you to get a good indication of how your new breast will settle into your body. You might feel further surgery to refine the shape of your new breast mound is necessary, but it is a personal choice. Revision surgery can take place anytime from three months post-surgery. Your surgeon may also recommend a breast lift or reduction on the other breast to create better symmetry. When you have achieved the desired symmetry and shape, you may like to consider the finishing touch of reconstructed nipples or 3D nipple tattoos.
Exercises after breast reconstruction using implants
Always check with your surgeon before commencing any exercise post surgery. Breast Cancer UK program
If you have had a tissue expander inserted, you will need to see your doctor regularly over several weeks or months to have the expander filled until the desired shape and size have been achieved for the implant. A support bra may be worn to help reduce swelling and support the reconstructed breast.
You may be prescribed painkillers, antibiotics and anti-inflammatory drugs when you are first discharged from hospital. It is vital to use these as prescribed to successfully manage any pain and to reduce the risk of infection.
Post-operative recovery can take longer if complications occur, so it is important to get adequate rest, make sure you follow your surgeon’s directions and exercise within the limits of comfort – if you feel any pain or pulling, especially around the wound sites, stop. It is normal to feel tired and sore after your surgery. Generally it is advised not to swim, play sports, exercise or do any heavy lifting for at least two weeks after your surgery. There is no set rule when it comes to your recovery time. Your Specialist Plastic Surgeon will prepare detailed instructions on post-operative care – make sure you follow these carefully.
It can take up to twelve months to completely heal and for scars to fade and for you to get a good indication of how your new breast will settle into your body. You might feel further surgery to refine the shape of your new breast mound is necessary, but it is a personal choice. Revision surgery can take place anytime from three months post-surgery. Your surgeon may also recommend a breast lift or reduction on the other breast to create better symmetry. When you have achieved the desired symmetry and shape, you may like to consider the finishing touch of reconstructed nipples or 3D nipple tattoos.
Exercises after breast reconstruction using implants
Always check with your surgeon before commencing any exercise post surgery. Breast Cancer UK program
Reviewed by:
Dr Pouria Moradi
MBBS BSc (Med)
MRCS (Eng) FRACS (plas)
Section on Aeroform reviewed by:
Dr Fred Clarke
BSc (Hons Biochem)
MBBS FRACS (Plastic Surgery)
Reference sources:
Breastcancer.org:
http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants
Australian Society of Plastic Surgeons:
http://www.plasticsurgery.org.au/protecting-patient-safety/breast-reconstruction-awareness-day/
Cancer Australia:
http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/breast-reconstruction/types/
Randwick Plastic Surgery: Patient Information Sheets
http://www.randwickplasticsurgery.com.au
Better Health Channel:
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/B10lite_en
Jane O’Brien: Specialist Breast and Oncoplastic Surgeon
http://www.melbournebreastcancersurgery.com.au/acellular-dermal-matrix.html
Breast Reconstruction.org:
http://www.breastreconstruction.org/TypesOfReconstruction/direct_to_implant.html
Macmillan Cancer Support:
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Surgery/Breastreconstruction/Reconstructionusinganimplant.aspx
AirXpanders website:
http://www.airxpanders.com/
Breast Reconstruction Options Have Been Xanded 2015 Jane Goodwin-Moore, article Link
Dr Pouria Moradi
MBBS BSc (Med)
MRCS (Eng) FRACS (plas)
Section on Aeroform reviewed by:
Dr Fred Clarke
BSc (Hons Biochem)
MBBS FRACS (Plastic Surgery)
Reference sources:
Breastcancer.org:
http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants
Australian Society of Plastic Surgeons:
http://www.plasticsurgery.org.au/protecting-patient-safety/breast-reconstruction-awareness-day/
Cancer Australia:
http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/breast-reconstruction/types/
Randwick Plastic Surgery: Patient Information Sheets
http://www.randwickplasticsurgery.com.au
Better Health Channel:
http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/pages/B10lite_en
Jane O’Brien: Specialist Breast and Oncoplastic Surgeon
http://www.melbournebreastcancersurgery.com.au/acellular-dermal-matrix.html
Breast Reconstruction.org:
http://www.breastreconstruction.org/TypesOfReconstruction/direct_to_implant.html
Macmillan Cancer Support:
http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Surgery/Breastreconstruction/Reconstructionusinganimplant.aspx
AirXpanders website:
http://www.airxpanders.com/
Breast Reconstruction Options Have Been Xanded 2015 Jane Goodwin-Moore, article Link