Implant-based reconstruction is a popular procedure that offers an acceptable cosmetic outcome without having to use tissue from another part of the body. There are two types of implants: saline-filled and silicone gel-filled. Both types of implants come in numerous shapes, sizes and profiles. Despite controversy over silicone implants in the 1990s, they have been ruled safe and effective by the Food and Drug Administration. Your surgeon will help determine which implant is best for your body shape.
Depending on their lifestyle and preference, patients may choose implants over tissue-based reconstruction. The best candidates for implant reconstruction are women with an adequate skin "pocket" to hold the implant (skin-sparing mastectomy); who don't have adequate tissue of their own or do not want to use their own tissue; or who have no history of radiation treatment.
Advantages of Implant Reconstruction
- Decreased surgery and recovery time
- Fewer scars
- Satisfactory shape in clothing
Disadvantages of Implant Reconstruction
- Need frequent office visits for the tissue expansion process
- Two-stage procedure: tissue expander followed by exchange for permanent implant
- Hard to achieve nipple projection with nipple reconstruction, due to thinner skin
- Difficult to achieve symmetrical shape with the natural breast
- Need to replace implants periodically, meaning more surgery
Breasts reconstructed with an implant alone will not create a natural droopy appearing breast and may appear fuller in the upper half compared with a natural breast.
Implant Reconstruction Procedure
Following mastectomy, your reconstructive surgeon will insert a tissue expander (a silicone balloon filled with saline) in a pocket formed under the muscle and remaining skin on your chest wall. More saline solution is gradually added to the tissue expander during outpatient clinic visits, stretching the muscle and skin to the desired size. Often the skin is stretched slightly more than needed because it has a natural tendency to shrink when the tissue expander is removed.
The amount of saline needed for each expansion may vary depending on the tightness of the skin. This process usually takes two to three months, but may take longer if you need other cancer treatments, such as chemotherapy.
Once the "pocket" has reached the desired size, the expander is left in place, stretching your skin for approximately one to two months more. Surgery is then scheduled to remove the tissue expander and replace it with a permanent implant, which is an outpatient surgical procedure. The permanent implant will either be filled with saline or silicone and will be much softer than the tissue expander. Your reconstructive surgeon can discuss the various types of available breast implants.