Breast Implant Surgery for Breast Reconstruction
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.
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.
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.
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. You can ask to talk to women who have had the surgery.
Before having this surgery or any other surgery, you may want to 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 will give you instructions on how to care for your incision. Your doctor may also prescribe antibiotics to help prevent infection.
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 better about their bodies, more alive, feminine, and sexual—and happier about life.
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).
Compared to tissue flap surgery for breast reconstruction, breast implant requires a shorter surgery and has a quicker recovery time.
A breast implant will likely need to be replaced at some point. Some implants have lasted 20 to 30 years, but that is not common. This means that someday you will probably need to have surgery to replace the implant.
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. It occurs when scar tissue around the implant hardens and begins to squeeze the implant. Surgery may be needed to remove the scar tissue or replace the implant.
- 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.
- Results that don't look perfect.
- Uneven breasts. Breasts with implants don't sag with age like natural breasts. This could be a problem if you just have one breast implant.
- Silicone implants that leak. Silicone implants can leak inside the body without causing any symptoms.
Some women are at higher risk for problems from surgery. This includes women who:
- Are obese.
- Have high blood pressure.
- Have diabetes.
- 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.
The U.S. Food and Drug Administration (FDA) monitors the safety of breast implants. The FDA reports that both saline- and silicon-filled breast implants appear to be safe.
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.
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