What is a breast reconstruction with an implant or tissue expander?

A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy (removing all your breast). Your surgeon will use a breast implant or tissue expander (expandable implant) to recreate the shape of a breast.

What are the benefits of surgery?

You should get a breast shape again. The reconstruction should give you a cleavage when you wear a bra.

Are there any alternatives to a breast reconstruction with an implant or tissue expander?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It is possible to recreate a breast shape using only tissue from another area of your body.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes one to two hours.

If you have already had a mastectomy there is usually not enough skin to recreate a breast shape so you will need a tissue expander to stretch your skin. Your surgeon will make a cut on the front of your chest over the mastectomy scar, or at the lower end of your new breast.

If the reconstruction is being performed at the same time as the mastectomy, your surgeon will usually be able to leave most of the skin on your breast, allowing them to place a permanent implant to recreate a breast shape.

Your surgeon will create a pocket under the muscle to place the tissue expander or implant in (see figure 1).

What kind of breast implant should I choose?

All implants are made of an outer layer (shell) of silicone. They can be filled with silicone or saline (salt water). The silicone used to fill the implant can be in the form of a liquid or gel (cohesive silicone). Liquid silicone and saline implants give a softer and more natural feel. Cohesive silicone implants give a firmer feel and can come in more shapes, so they are often recommended to women who are having a breast reconstruction.

If you do not have enough skin or you have already had a mastectomy, your surgeon may need to use a tissue expander.

Is silicone safe?

Many studies have been carried out to find if silicone breast implants are safe. There is no evidence to suggest that women with silicone breast implants have a higher risk of developing autoimmune diseases, such as breast cancer and arthritis. There is a reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma but the increase in risk is small.

What complications can happen?

1 General complications of any operation

  • Pain
  • Bleeding
  • Infection of the surgical site (wound)
  • Unsightly scarring
  • Blood clots

2 Specific complications of this operation

  1. Breast reconstruction complications
  • Developing a lump under your wound
  • Wound breakdown
  • Skin necrosis
  • Difference in shape and appearance
  • Numbness or continued pain around your armpit or the inner part of your arm
  • Permanent numbness around the scar on your chest
  1. Implant complications
  • Developing a collection of fluid in the pocket where the implant is
  • Infection of the implant
  • Thickening and tightening of the scar tissue
  • Kinking and rippling
  • Rupture or deflation of the implant
  • Failure of the reconstruction

How soon will I recover?

You should be able to go home after two to three days and return to normal activities after four to six weeks.

Wearing a soft, well-fitted bra will help to relieve any discomfort.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

If your surgeon needed to use a tissue expander, you will need to come back to the clinic regularly.

The shape of your reconstructed breast takes several weeks to settle down. It can take up to a year for you to feel as if your reconstructed breast is part of you.

Summary

A breast reconstruction with a breast implant or tissue expander is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.

Acknowledgements

Author: Mr Eoin O'Broin MD FRCS (Plast.) and Mr Paul Roblin MSc FRCS (Plast.)

Illustrations: Medical Illustration Copyright © Nucleus Medical Art. All rights reserved. www.nucleusinc.com

 

This document is intended for information purposes only and should not replace advice that your relevant health professional would give you.

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