What is an Implant-Based Reconstruction?
Implant-based reconstruction offers an acceptable reconstructive option for patients who are undergoing a “skin sparing” mastectomy, prefer shorter surgery and recovery times, and want a more “perky” looking reconstruction without having to use tissue from another part of their body. This is the most common method of breast reconstruction currently performed in the US. Breast reconstruction with implants can be performed as a one-stage or two-stage procedure. Your reconstructive surgeon may place an immediate breast implant (saline or silicone) at the time of your mastectomy if the skin is healthy enough as a one-stage procedure or a tissue expander which acts as a temporary spacer at the time of your mastectomy which will be replaced at a later time with an implant for a two-stage procedure. A tissue expander is a silicone balloon filled with saline (sterile salt water). Following mastectomy, your reconstructive surgeon will insert the implant or tissue expander in a pocket formed under a muscle on your chest wall (pectoralis major muscle) and the skin remaining after the mastectomy. Some surgeons will discuss the use of a biologic product (acellular dermal matrix) derived from animal or human sources that can help cover the lower half of the implant or tissue expander.
If a tissue expander is placed, saline is added to the expander gradually during outpatient visits to the plastic surgery clinic. The tissue expander is filled with saline to help stretch the muscle and skin to the breast size desired. Often the skin is stretched slightly more than needed to achieve the desired size because it naturally shrinks when the tissue expander is removed. The amount of saline needed for each expansion may vary depending on the tightness of the skin. Most patients do not have much discomfort or pain with tissue expansion. The process of stretching the breast skin usually takes one to three months. It may take longer if you need other treatments for your cancer such as chemotherapy. Once your muscle and skin has stretched to the desired size, the expander is left in place for about one to three months longer. Then outpatient surgery is scheduled to remove the tissue expander and replace it with an implant.
Types of Breast Implants
Breast implants are much softer than the tissue expander. The implant will be filled with either saline or silicone. Saline implants have been approved by the Food and Drug Administration (FDA) since 1992. Before 1992, silicone gel implants were used. Due to silicone leakage and fears that silicone implants could cause cancer and autoimmune disease (such as lupus), silicone breast implants were removed from the market by the FDA in 1992. After 1992, large scale studies were conducted to determine the safety of silicone implants. These studies showed that there was no connection between using silicone implants and the development of cancer or autoimmune disease. In 2006, the FDA reversed its ban on silicone breast implants. Today, both saline and silicone implants are available and safe for breast reconstruction. Both types of implants come in many shapes and sizes. Your surgeon will discuss with you the differences between the various types of implants and determine which type of implant is best for you. Remember that implants may need replaced in the future and implant reconstruction differs substantially from the more familiar breast augmentation because we are building an entire breast rather than making a natural breast larger.
If you have received radiation therapy or are going to receive radiation therapy, implant only reconstruction may not be recommended. It may result in increased issues including infections, severe capsular contracture (scar around the implant), fluid build up, and a worse cosmetic result.
Questions to Ask Your Surgeon
- Would I be a candidate for implant based reconstruction- one-stage or two-stage?
- How will this match my breast that does not have cancer? Will I need surgery on my other breast to match?
- Will my other cancer treatment affect the reconstruction?
- How long will the implant last?
- What are the complications you have seen associated with this procedure?