Breast reconstruction with breast implants

Introduction

After mastectomy for breast cancer treatment, implants offer an option to rebuild the breast’s shape. This procedure aims to boost the patient’s self-confidence by recreating a natural breast shape using silicone or saline devices.

Although implants lack the permanence that comes with utilizing one’s own body tissues, implant reconstruction might suit patients desiring a relatively less complex surgical approach and faster recovery. Let’s understand the details of the procedure, the recovery process, the costs over time, and the aesthetic results possible.

How do implants rebuild the breast?

The implant device creates a breast form of one breast to match the other natural breast post-mastectomy. Reconstruction can begin immediately during the initial surgery or be delayed until completing other needed cancer therapies.

Typically placed under the chest muscle for coverage, implants come in various shapes and sizes. Round moderate profile implants suit most body types, while shaped “teardrop” implants work better for slender figures with less native breast tissue. Devices are available with a smooth or textured surface and silicon or saline gel filling.

The procedure 

Stage 1 involves inserting a tissue expander under the chest muscle and gradually inflating it over 4–6 months through external needle injections to stretch the skin enough for the final implants. Alternatively, definitive implant placement might follow immediately after mastectomy for small-breasted individuals needing less added volume.

Once the tissue expander reaches adequate pocket size, it is removed in the second stage and replaced with preferred left and right breast implants for symmetry. Further surgical sessions refine the shape, nipple position, and appearance as needed for the desired aesthetic outcome over 6–12 months post-mastectomy.

Types of breast implants

There are a few options when selecting the right breast implants to match individual reconstruction needs after mastectomy:

Silicone gel implants: Silicone has a softer, more natural feel than saline. This cohesive gel filler holds firmly even if the implant shell ruptures. Silicone devices come in round or contoured anatomically shaped profiles.

Saline implants: Saline refers to sterile saltwater filler approved for breast augmentation in those aged 18 years and older. Saline implants have a firmer look and feel compared to silicone gel. Being of a lighter weight, they might be recommended for petite frames.

Smooth shells: The external surface of a smooth shell implant influences aesthetic results. Smooth implants move freely along the implant pocket for the most natural mobile profile under clothing. They have a lower risk of ripping or palpability.

Textured shells: A textured implant shell adheres to surrounding breast tissue, preventing its movement or rotation. Some data indicates that textured devices have a slightly higher soundness rate and a lower chance of capsular contracture.

When determining the best reconstruction choice, your surgeon will consider the implant shape, gel/saltwater filler variations, shell textures, and base diameter options to attain the optimal life-like breast shape for you after mastectomy surgery. Implant-based reconstruction aims to make a cancer previvor feel whole again.

Recovery after implant reconstruction surgery

Hospital stays usually extend 1–2 nights for expander placement or implant swap surgery. Drainage tubes are placed to prevent fluid buildup and removed after 2–3 weeks. Medications manage surgery-related pain, and antibiotics prevent infection risk in implants.

Post-operative activity is restricted for 4–6 weeks to protect the healing tissues around the implant and expander device. Follow-up visits continue until the reconstruction outcome is deemed satisfactory, often at one-year post-mastectomy. Scar massage helps fade incision lines while implants settle into position.

Life with breast implants 

Reconstructed breasts take 3–6 months to achieve the final shape and droop. Unlike natural soft tissue, implants might feel firmer but should not be painful. Implants might need occasional adjustments for optimal symmetry and aging replacements every 10–15 years.

While implants can rupture over time, monitoring helps early detection. Irritated and swollen tissue can be an early sign of a rupture. However silicon breast implant ruptures are often silent, i.e., without any sign or symptom. Breast implant ruptures can be spotted through an imaging test, like an MRI or an ultrasound.

Certain risks do exist, like capsular contraction or BIA-ALCL lymphoma, albeit at a very low rate. Strict hygiene around implants and avoiding trauma to the chest during contact sports or seat belt injuries are advised.

Comparison with flap reconstruction surgery

The main advantage of using implants includes shorter, simpler surgery than flap reconstruction (the patient’s own tissues are used), which requires microsurgical expertise. However, autologous flaps better mimic a supple natural feel permanently since they utilize living body fat/skin rather than artificial devices.

While implants spare additional scars or recovery from the flap donor sites, they do incur repeated costs for planned device replacements or upgrades over a lifetime. So, discussing the pros, cons, and lifestyle priorities associated with both approaches with your plastic surgeon is advised.

Maintenance

Implant-based breast reconstruction can renew the self-image of the patient after mastectomy through a relatively less complex approach than flap procedures, albeit requiring replacement surgery every decade or so. Selecting an expert team and option well-suited to your body and requirements allows positive transformation.

Due to the risk of ruptures for silicon- or saline-based implants, the United States Food and Drug Administration (FDA) recommends MRI screenings 5–6 years following breast reconstruction surgery and every 2–3 years after that. Routine mammograms of the reconstructed breast are usually not required. 

FAQs

How do implants compare to flap surgery over the long term? 

Implants spare extensive flap surgery but need replacement every 10–15 years, while autologous flaps are more permanent. However, flap reconstruction also entails donor site recovery. Discuss options thoroughly with your plastic surgeon.

What is done for aging or ruptured implants?

Over time, implants might rupture, deflate, or become misshapen, requiring removal. Replacement devices restore the breast reconstruction outcome. Enhancements can also upgrade implant type/size for improved symmetry or aesthetics.

Can implants disrupt other imaging tests? 

While implants can obscure mammogram views requiring specialized films, they do not affect ultrasound, MRI scans, or biopsies. So, breast cancer screening is still fully possible alongside self-exams to check for potential disease recurrence.

How is the best implant type chosen?

The plastic surgery team considers your body type, lifestyle factors, breast shape goals, added volume needed, and your mastectomy results to recommend the optimal implant filler, size, and profile configuration customized just for you.

When can I get back to normal activity after implant surgery? 

Initial recovery takes 4–6 weeks with no straining exercise that could disturb the healing tissues around the implanted devices. By 2–3 months, light cardio and conditioning may be permitted. But some precautions apply lifelong to protect the implants.

Will implants influence cancer detection?

Breast implants do not interfere with mammograms but might need specialized views. Self-exams and clinical breast exams can be done routinely to check for recurrence. Address new symptoms like pain or lumps promptly.