Breast implant surgery for breast reconstruction

Surgery Overview

Breast implants are a way to recreate the shape of a breast after part or all of the breast is removed (mastectomy) because of cancer. It may also be done for women who have problems with breast development.

A breast implant is a soft silicone shell filled with saline (salt water) or silicone gel. Silicone may create a more natural-looking breast, because its weight and texture is more like breast tissue. But saline is used most often, because it can be safely absorbed by the body if the implant leaks.

To place the implant after mastectomy, the surgeon will use the same cut (incision) that was used to remove the breast tissue. The implant may be placed directly under the skin, but it is usually put under the chest muscle. After the implant has been carefully adjusted to the correct shape and position, the incision is closed with stitches.

Breast reconstruction usually takes more than one surgery. Sometimes an implant is placed during the same surgery as mastectomy. The nipple and the brown area around it (areola) are created at a later time. But often, the doctor will first place a balloon (tissue expander) beneath the chest muscle. Saline is added to the balloon every 1 to 2 weeks to help stretch the skin and muscle. This may take several months. When the right size is reached, the balloon is taken out and an implant is put in.

See a picture of a breast implant and tissue expander.

Implant surgery is done by a plastic surgeon. The breast surgeon who does your mastectomy can refer you to a plastic surgeon with special training in breast reconstruction.

You will meet with the plastic surgeon before your mastectomy to discuss the best procedure for you. The surgeon can show you pictures of other women who had implants after mastectomy. Ask to see both the best and worst results so you can get a better idea of what can happen. You can also ask to talk to women who have had the surgery.

If you are not comfortable with the surgeon or the recommended treatment, you can see another surgeon to get a second opinion.

What To Expect After Surgery

Breast implant surgery is usually done using general anesthesia, so you sleep during the procedure. When you wake up from surgery, you will have bandages over the surgery sites, and you may wear a special bra that holds your bandages in place. You may have drainage tubes to collect fluid and keep it from building up around the surgery site.

If the implant was placed at the same time as your mastectomy, you may stay in the hospital for 2 or 3 days. If the implant is placed later, you will probably be able to go home the same day.

Most women have soreness, redness, and swelling in the breast after implant surgery. You may need pain medicine for a week or two. Your doctor may also prescribe antibiotics to help prevent infection.

About 4 weeks after surgery, when the incision heals, you can massage the area with a mild lotion, vitamin E, or pure lanolin. Do not use perfumed lotions or any product that contains alcohol. The massaging action may lower the chance that tough scar tissue will form around the implant.

You may be able to go back to work or your normal routine in 3 to 6 weeks or sooner. Most women need to avoid strenuous activity for several weeks.

Why It Is Done

Breast implant surgery can be done to restore the appearance of a breast after mastectomy. It may also be done for women who have problems with breast development.

Breast reconstruction may help a woman feel better about her appearance. Some women say it helps them feel more whole and less "robbed" by cancer.

How Well It Works

Breast implants work best for women who have small breasts (A or B cup) or for women who have both breasts removed (bilateral mastectomy). An implant may not work as well for a woman whose other breast droops.

Compared to tissue flap surgery for breast reconstruction, breast implant requires a shorter surgery and has a quicker recovery time.

A breast implant may not last the rest of your life. You may need to have later surgery to replace the implant.

Risks

Many of the risks associated with breast reconstruction are the same as those with any surgery: infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery.

Other risks from breast implants include:

• Capsular contracture. This is one of the most common problems caused by breast implants. It occurs when scar tissue around the implant hardens and begins to squeeze the implant. It can cause hardening of the breast tissue, rippling in the skin of the breast, and changes in the shape of the breast. It may also be painful. Surgery is sometimes needed to remove the scar tissue or replace the implant when capsular contracture develops.
• Changes in the implant. Normal activity or an injury to the breast can damage the implant, causing it to leak, deflate, or rupture. Over time, the implant may harden, develop ripples, shift position, or change shape. Surgery may be needed to remove the implant and replace it if any of these changes occur.
• Collection of blood or clear fluid in the wound.
• Abnormal scarring (uncommon).
• Silicone implants that leak. Silicone implants can leak inside the body without causing any symptoms. To catch this problem, the U.S. Food and Drug Administration (FDA) recommends that women who get silicone implants have regular MRI tests starting 3 years after they get the implant and every 2 years after that.

Some women are at higher risk for problems from surgery. This includes women who:

• Are obese (BMI over 35).
• Have high blood pressure.
• Have diabetes.
• Smoke.
• Are in poor health.

What To Think About

It is important to know that your breasts will look different after surgery. Your new breast may feel firmer and look rounder or flatter than your other breast. Some women have surgery on the other breast to make them look as much alike as possible. Other women find that wearing a bra hides the differences.

The incisions will leave scars on your breasts. These will fade with time. The surgeon will try to make incisions that leave as few scars as possible.

Some women choose to get a breast implant first and have tissue flap surgery later, when they feel stronger or have more time. For more information about this type of surgery, see:

Tissue flap surgery for breast reconstruction.

In 2006, the U.S. Food and Drug Administration lifted restrictions on the sale of silicone breast implants for both reconstructive and cosmetic surgery. Studies done between 1992 and 2006 did not find evidence of a link between silicone implants and connective tissue diseases or cancer. Further studies are being done to find out how safe silicone implants are over a woman’s lifetime.¹

Federal law requires insurance companies that cover mastectomy for breast cancer to also cover breast reconstruction. Check with your insurance company to find out what your costs will be. If you are considering a silicone implant, you will want to find out if your insurance will pay for the cost of follow-up MRIs.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Other Places To Get Help

Book

Dr. Susan Love's Breast Book (4th revised edition)
Author/Editor:	S.M. Love K. Lindsey
Publisher:	Perseus Books Group
Publication Date:	2005
In this book, Dr. Love presents medical information in a simple, welcoming style, with plenty of illustrations to help make the information even clearer. About two-thirds of the book deals with breast cancer: risk factors, prevention, screening, diagnosis, staging, emotions, treatment options, surgery, alternative treatments, clinical trials, and more. The book also includes information about breast development, physiology, bras, nursing, and sexuality.

Organization

American Cancer Society
Phone:	1-800-ACS-2345 (1-800-227-2345)
TDD:	1-866-228-4327 (toll-free)
Web Address:	www.cancer.org
The American Cancer Society conducts educational programs and offers many services to people with cancer and to their families. Staff at the toll-free numbers have information about services and activities in local areas and can provide referrals to local ACS divisions.

Author:	Kathe Gallagher, MSW	Last Updated: August 31, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Douglas A. Stewart, MD - Medical Oncology
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