Implant Reconstruction


Using an implant to rebuild the breast requires less surgery than flap reconstruction, since it only involves the chest area (and not a tissue donor site). Still, it may require more than one procedure. It also may require additional surgery in the future, as implants can wear out and develop other issues, such as tightness of scar tissue around the implant.

The implant can be filled with:

  • saline (salt water)
  • silicone gel
  • a combination of the two -- silicone or vegetable oil in the outside chamber and saline on the inside

The implant is placed under the pectoral chest muscle. For implant reconstruction, the length of the surgery and your time of recovery are usually shorter than for flap reconstruction.

Direct to Implant Reconstruction
Direct to Implant Reconstruction -- Before and After

Implants usually don't last a lifetime, so you'll probably need more surgery to replace an implant at some point. The American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons say that both saline and silicone implants last between 10 and 20 years.

Implants may be a good option for thin women with small breasts because these women often don't have enough extra tissue on their bellies, backs, thighs, or buttocks to form a good breast shape as required by flap reconstruction. However, some of the very newest advancements in flap reconstruction have begun to address this problem by using “stacked” or multiple-layered flaps.

Implant reconstruction is also a good option if:

  • You’d like to avoid incisions in other parts of the body (donor sites) or sacrificing the muscle structure in donor sites. Also keep in mind that the newest flap procedures preserve muscle and may be worth exploring if you’re concerned about this.
  • You do not need radiation therapy. There is a high chance of developing problems in an implant reconstruction after radiation.
  • You can’t or don’t want to endure a lengthier flap reconstruction operation.
  • You are willing to surgically alter your healthy breast to achieve symmetry or balance. It is not always easy to match an implant, which has a fixed shape, to the remaining natural breast. For more information, see our section on Altering the Opposite Breast.

Implants come in teardrop or round shapes. One of these shapes may be a better match for the contour of your breast area. The surface of the implant may be smooth or have a slightly rough texture -- but you won’t feel this through your skin. However, you’ll likely be able to feel wrinkles and the texture of the implant when you rub your hand over the breast, particularly the lower part. Your plastic surgeon may prefer one type of implant over another for technical reasons. In some cases, implants with a slightly rough texture may help lower the risk of scar tissue forming around the implant.

You may have implant reconstruction at the same time as mastectomy (immediate reconstruction), after mastectomy and other treatments (delayed reconstruction), or you might have the staged approach that involves some reconstructive surgery being done at the same time as mastectomy and some being done after (delayed-immediate reconstruction).

Implant reconstruction after mastectomy may be more difficult since the skin of the breast will have been removed. In this case, tissue expansion, or stretching of the remaining skin, would be attempted by your plastic surgeon. A surgery to insert a balloon-like expander would be performed, and the expander would be gradually filled with saline over the course of weeks to stretch the skin. Expanding skin this way can be difficult and sometimes doesn’t work, particularly after radiation because the skin is tough and resistant to stretch. Once expansion is complete, you have another operation to swap out the expander for the final implant. You and your surgeon can discuss what’s best for your situation.

Implant vs. flap reconstruction: Potential advantages and disadvantages

Advantages over flap

  • shorter, less complex surgery
  • uses the mastectomy incision for procedure (doesn’t create new scars)
  • sometimes can be completed in one step
  • easy to find qualified surgeons

Disadvantages vs. flap

  • overall reconstruction process can take longer (multiple steps, multiple office visits to receive tissue expander injections)
  • less likely to feel, look, or move like a natural breast
  • subject to future problems such as rupture, deflation, capsular contracture
  • opposite healthy breast often needs surgery to match the implant
  • generally not a good option if skin has undergone radiation
  • implant won’t last a lifetime

Source: Kathy Steligo, The Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery (Baltimore: Johns Hopkins, 2012)

Saline vs. silicone: Saline implants are the most common implant used. While the shell is made of silicone, the implant is filled with a salt water solution known as saline. Saline implants tend to feel firmer than silicone implants. There is also more wrinkling under the skin that can be felt with this type of implant.

Saline implants have been more popular because of concerns that silicone implants might leak and cause immune system diseases. But research has shown that silicone implants don't increase the risk of immune system disorders; the U.S. Food and Drug Administration approved the use of silicone gel-filled breast implants for breast reconstruction in 2006.

Silicone gel implants are filled with liquid or firm silicone gel. They tend to feel softer than saline implants and some women think the texture is more like natural breast tissue.

A type of silicone implant known as a “gummy implant” gives more natural shape to the reconstructed breast. Gummy implants are a bit firmer than regular silicone implants, so there’s less risk of the wrinkling that can sometimes be visible through the skin with some implants. There’s also less of a risk for hard scar tissue to form around the implant (capsular contracture) because of the texture of the implant.

All implants have a slight risk of rupturing. If a saline implant ruptures, the saline leaks out quickly and the breast appears somewhat deflated, so you know immediately that it's ruptured. The salt water is absorbed by the body. If a silicone implant ruptures, the gel leaks out more slowly because it's thicker. It may take you longer to realize that the implant has ruptured, or you may not realize it at all since the leaked material can remain around the implant. Silicone gel is not absorbed into the body; the gel can sometimes leak into the pocket surrounding the implant and stay there, or it may spread further. In either case, surgery would be required to replace the implant.

If you’re concerned about the safety of silicone in your particular situation, saline-filled implants can be a more reassuring alternative.

Talk to your surgeon about which type of implant is best for you. Ask if you can handle a sample implant of each material so you can decide if you prefer one texture over the other.

Researchers are studying alternative breast implants that are filled with different materials, but these types of implants are available only if you're a participant in a clinical trial. Talk to your surgeon if you're interested in being a participant in an alternative implant trial.

Comparing saline and silicone implants

Characteristic Saline Implant Silicone Implant
Components Silicone shell filled with salt water Silicone shell with silicone gel interior
Texture Not as soft as silicone Soft, like natural breast tissue
Incision required Shorter: implant is deflated when inserted Longer: implant is full when inserted
Interior substance Filled by surgeon during operation Pre-filled by manufacturer
Rupture Obvious May be undetected
Follow-up recommended None Periodic MRI screening

Source: Kathy Steligo, The Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery (Baltimore: Johns Hopkins, 2012)

In this section, you can learn more about what to expect with implant reconstruction, including the risks:

Photographs included in this section are images of surgical procedures performed by the Center for Restorative Breast Surgery and have been generously donated to Breastcancer.org.

CRBS Acknowledgement

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