Breast Reconstruction with Implants

Overview

Breast reconstruction using implants is a medical procedure that helps restore the shape of a breast, usually after mastectomy for breast cancer. In this type of reconstructive surgery, a specially trained plastic surgeon uses silicone implants, which are typically filled with a gel, to recreate the breast’s shape and size.

Key facts about implant-based breast reconstruction:

Surgeons commonly perform this procedure after removing all breast tissue.
The process most often starts during the initial surgery for cancer treatment.
Patients usually need more than one operation to reach the final results.
Surgeons use silicone implants as the standard materials.

Although the goal is to achieve a natural look and feel, the reconstructed breast may not have the same texture or sensation as a natural breast. Each patient’s experience may be different. Some people find that reconstructive surgery helps improve confidence and comfort with their body.

Surgery Type	Typical Material	When Performed
Implant-Based	Silicone Gel Implants	Often during mastectomy

Reasons for Considering Breast Reconstruction with Implants

Many patients choose breast reconstruction with implants after a mastectomy, lumpectomy, or other cancer surgery to help restore the look and feel of the breast. This surgery can help people regain self-confidence and a sense of normalcy. Why patients choose implant-based reconstruction:

Improves Body Image: It can help provide a natural breast shape.
Less Invasive: Compared to tissue flap procedures, implant surgeries are usually less complex and require a shorter recovery time.
Works with Different Types of Surgery: It is an option for people who have had a mastectomy, nipple-sparing mastectomy, or lumpectomy.

Implant reconstruction does not last for life. Most people may need more surgeries later to replace or remove the implant. This differs from reconstruction using a tissue flap, which usually does not require more procedures in the future.

Many aspects must be considered before surgery, such as overall health, cancer treatment plans, and personal preferences. A discussion with a plastic surgeon is important to find the best option for each person.

Possible Side Effects

Surgery-Related Concerns

Several complications can happen during or after breast reconstruction surgery. Common risks include slow wound healing, where cuts may take longer to close. Infections can develop at the surgical site, which may require medicines or extra treatment.

Patients may experience bleeding during or after the operation, and surgeons may need to perform additional procedures to address it. General anesthesia can cause side effects such as nausea, vomiting, and confusion in the hours following surgery.

Patients who need radiation therapy after a mastectomy may heal much more slowly. The skin and tissue can become more fragile, possibly causing a higher risk of infection and wound problems.

Implant-Related Issues

Breast implants present their own set of challenges. Some people may notice unevenness in breast size or shape after surgery. Others may experience pain or discomfort in the breast area.

Occasionally, implants can leak or tear, which may require future surgeries to repair or remove them. Capsular contracture can occur when scar tissue forms tightly around the implant, changing its appearance and sometimes causing pain.

Patients with textured implants face a small increased risk of a rare immune system cancer called BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). Additionally, swelling in the arm, known as lymphedema, can sometimes develop after reconstruction.

Complication	Related to
Slow healing, infection	Surgery
Bleeding	Surgery
Anesthesia side effects	Surgery
Asymmetry, pain	Implants
Implant leaks, replacement	Implants
Capsular contracture	Implants
BIA-ALCL (rare cancer)	Textured implants
Lymphedema	Surgery/Implants

Note: Additional treatments or surgeries might be needed to manage some of these complications.

Getting Ready for the Procedure

Preparing for breast reconstruction with implants begins with a meeting with a board-certified plastic surgeon. Choosing a surgeon with experience in breast reconstruction after a mastectomy is important. The breast cancer surgeon and the plastic surgeon work together to create a more effective treatment plan.

The surgeon explains the available surgical techniques and what to expect before, during, and after surgery. They may show examples or photos to help patients understand their options and outcomes.

The team discusses factors such as body type, overall health, treatment history, and possible donor sites like the back, lower abdomen, or buttocks to select the most suitable method. Before surgery, the treatment team usually provides a checklist that may include:

Stopping or changing some prescription medicines.
Avoiding food or drink before the procedure.
Quitting smoking (this is important for proper healing).
Arranging for someone to drive home after surgery.

Following instructions from the healthcare team is essential for safety and results. Patients are encouraged to talk openly with their plastic surgeon about whether to have surgery on the other breast for symmetry. Asking questions and understanding every step can help reduce worries and prepare for the process.

Table: Topics to Discuss with Your Surgeon

Topic	Details to Ask About
Surgical technique	Pros and cons for your body type
Anesthesia	Type and possible side effects
Donor site options	Back, lower abdomen, buttocks
Recovery plan	Time off and possible follow-ups
Additional procedures	Need for further surgery

What to Expect

Getting a Breast Implant During Mastectomy

A plastic surgeon can place a breast implant during the same surgery as a mastectomy. This method is called immediate implant placement. The patient is under anesthesia as the surgeon completes the mastectomy and then puts in the implant. Most implants are silicone gel-filled, but saline-filled options are available.

The surgeon can position the implant in front of (prepectoral) or behind (subpectoral) the chest muscle. Sometimes, mesh or a special tissue, called acellular dermal matrix, supports the implant. Over time, the patient’s body replaces this tissue with its own. A table can help compare options:

Placement	Description	Common Fill Material
Prepectoral	In front of chest muscle	Silicone, saline
Subpectoral	Behind chest muscle	Silicone, saline

Extra procedures, such as additional flap surgeries—like latissimus dorsi flap, abdominal flaps, or DIEP flap—may be considered in some cases for extra support, but implant-only approaches are most common for this technique.

Using a Balloon-Like Device to Stretch Skin

Most people do not get a full-size breast implant right away. Instead, the surgeon places a tissue expander, which is a soft balloon-like device, under or over the chest muscle. This is called immediate tissue expansion.

The surgeon gradually fills the tissue expander with saline over weeks or months. The patient visits the healthcare team every week or two, and they add more saline through a small valve under the skin. This slow filling helps the skin and tissue stretch to make room for a future implant.

After enough stretching, the surgeon removes the expander and puts in a permanent implant, usually after three to six months. The implant is often silicone and is chosen based on the patient’s needs. Flap methods such as TRAM flap or SIEA flap are sometimes discussed if extra tissue is needed.

Key Points

Expander Types: Saline-filled, with or without support tissues.
Typical Timeline: Several months of gradual stretching.
Follow-Up Surgery: Removal of expander, implant placement.

Delaying Reconstruction Surgery

Some people decide to postpone reconstruction. Delayed breast reconstruction may happen months or years after the initial mastectomy. When this happens, the process often begins with putting in a tissue expander to stretch the chest area, just as with immediate expansion.

After the skin and tissue have been expanded enough, the expander is removed and replaced with an implant. Plastic surgeons often suggest starting reconstruction at the same time as the mastectomy for better results, as waiting makes it harder to get a natural-looking shape.

Implant reconstruction may involve saline or silicone implants. Occasionally, combining implant placement with tissue reconstruction techniques, like a DIEP flap or latissimus dorsi flap, offers improved shaping if more tissue is needed.

What Recovery Is Like After Surgery

After implant or tissue expander surgery, patients may wear a snug bandage or a special support bra to control swelling. Surgeons may leave drainage tubes in the body for a short time to remove extra fluid or blood. Doctors often prescribe pain medication during the first days.

Recovery takes time. Most people experience tiredness, soreness, and a need for rest for several weeks. Temporary limits on activities, such as not lifting arms above the head or avoiding heavy lifting, are common. A simple checklist can help keep track of recovery steps:

Wear a support bra as advised
Monitor for swelling or fluid buildup
Avoid heavy lifting or overhead motion
Take prescribed pain medicines
Report any concerns to the plastic surgeon

Follow-up appointments are important. Patients should contact their surgery team if they notice unusual pain, redness, or swelling.

Making or Restoring a Nipple

When the original nipple is removed, a person may choose to have a new nipple created. This is called nipple reconstruction. A plastic surgeon can use small pieces of skin to shape a new nipple. Many people choose to get a tattoo to add color to the nipple or the area around it, known as the areola.

Nipple reconstruction usually occurs after healing from breast reconstruction, but sometimes both surgeries can happen at the same time. Not everyone decides to have their nipple reconstructed; it’s a personal choice.

How to Manage Breast Cancer Checks Going Forward

If someone had only one breast reconstructed, mammograms remain necessary for the natural breast. Screenings are usually not needed for breasts made with implants or tissue, but self-exams of the area and remaining natural breast are still important.

Key Tips

Continue routine mammograms on any natural breast tissue
Practice self-exams for changes such as lumps or skin changes
Inform a healthcare professional if noticing anything unusual

Unlike with natural tissue, reconstructed breasts (with silicone or saline implants) do not need regular cancer screening, but regular checkup visits help ensure implants and tissue stay healthy.

Types of Breast Implants and Techniques

Saline Implants: Filled with sterile salt water; can be adjusted for size.
Silicone Implants: Gel-filled, often preferred for a more natural feel.
Tissue Expanders: Used temporarily to stretch skin.
Tissue Flap Options: Such as deep inferior epigastric perforator (DIEP), transverse rectus abdominis myocutaneous (TRAM), superficial inferior epigastric artery (SIEA), and latissimus dorsi flaps, which use the body’s own tissue—often from the abdomen or back—for extra support or shaping during breast reconstruction.

Summary Table: Implant Reconstruction Methods

Technique	Steps (Simplified)	Common Uses
Immediate Implant	Implant placed at mastectomy	Quick recovery
Immediate Tissue Expander	Expander placed, then implant	Gradual stretching
Delayed Reconstruction	Expander and implant later	After healing, waiting
Flap + Implant	Combines body tissue and implant	Extra support, shaping

Each approach depends on the patient’s health, cancer treatment plan, personal preferences, and guidance from the surgical team. Ongoing care, regular checkups, and communication with a qualified doctor help guide every step of the process.

Outcomes

Breast reconstruction with implants restores the shape and form of the breast after surgery. While the tissue needs time to heal, patients often work closely with their care team to check on progress and discuss any changes. The main aim is to create a breast that looks and feels as natural as possible, though the reconstructed breast will not be exactly the same as the original breast.

What Breast Reconstruction Offers

Gives the breast a defined shape
Helps both breasts look similar under clothes or swimwear
Removes the need for a breast-shaped form (prosthesis) inside a bra

Possible Benefits

May help boost self-confidence
May reduce some visible reminders of previous health issues

Limitations

The reconstructed breast will not look or feel exactly like the natural breast
Normal sensation in the breast usually does not return

Benefit	Description
Improved Shape	Provides a new breast form after surgery.
Clothing Appearance	Makes both sides look similar in clothing.
Boosted Self-Confidence	Can support positive feelings about body image.