Breast Implants

Breast implants involve the least amount of surgery of all your reconstruction options. Slim, small-breasted women tend to do best with breast implants, because they often don't have enough excess belly tissue to form a good tissue transplant. Also, it's easy to achieve a smaller breast size with implants. Breast implants only come in three sizes (small, medium, and large) and the largest is a size 12–14. In Hollywood, size 12 or 14 may be "large," but in the real world, it's small potatoes.

In January 2011, the U.S. Food and Drug Administration reported a possible link between both saline and silicone breast implants and a very rare form of lymphoma -- anaplastic large-cell lymphoma (ALCL) -- in the tissue near the implant.

The possible link came to light when a study identified 34 women diagnosed with ALCL in a breast with an implant. Because ALCL is incredibly rare, the researchers doing the study and the FDA took notice when these women were diagnosed.

Breast ALCL usually developed in and around the tissue capsule that forms naturally forms around an implant.

It's very important to know that the FDA ISN'T SURE that a link exists between breast implants and breast ALCL. The FDA has emphasized that even if there is a link, the risk of breast ALCL in women with breast implants is still extremely low. Currently available FDA-approved breast implants are safe when used as recommended by the manufacturer. The FDA advised "women with breast implants who are not showing any symptoms or problems, such as pain, lumps, swelling, or asymmetry, require only routine follow-up."

If you're considering implants, know that the FDA doesn't think that the possible link between implants and ALCL should discourage women from implant reconstruction.

If you have a breast implant, be reassured by the FDA's advice about implants. Still, don't hesitate to call your doctor if you're concerned. Definitely call your doctor if you have symptoms or problems with your implant, such as pain, lumps, swelling, or asymmetry.

Making room with expanders

Filled tissue expander

• Larger Version

For most women, the skin that remains after mastectomy must be stretched or expanded to make room for an implant. To stretch the skin, the surgeon inserts a balloon-type device called a tissue expander under the chest muscle. The expander has a port (a metal or plastic plug, valve, or coil). The port allows the surgeon to add increasing amounts of liquid over time (about six months), without extra surgery.

Gradually, your skin and soft tissue are stretched to achieve your desired appearance. The tissue is actually stretched a little beyond your desired size, to create a natural droop. If the tissue is stretched too far, it can cause discomfort and occasionally flatten part of your rib cage. Ask your doctor how she or he plans to prevent this from happening.

Final steps

When stretching is done and your other treatments (chemotherapy, radiation, or both) are completed, the expander is usually replaced with a permanent implant. Breast implants are filled with either saline or silicone gel.

Sometimes, a surgeon may use a permanent expander. This device doubles as an expander and an implant. When stretching is completed and the "expander" is filled to the right amount with saline, the port is removed. Voila—you have a breast implant, with no extra surgery.

Scar tissue

Once a breast implant is in place, scar tissue forms all around it, forming what's called a tissue capsule. Most of the time, these tissue capsules are soft-to-firm, and unnoticeable. However, less than 15% of the time, a hard capsule forms that can be painful and distort the breast. In these cases, a surgeon can break up the scar tissue and, if necessary, replace the implant.

If you have radiation therapy to the breast area, the risk of scar tissue and hardening around the breast implant increases to 40–50%.

Massage and exercises may reduce the risk of forming a hard capsule (with or without radiation). You can ask your surgeon to show you how to massage the implant and the area around it, firmly but gently.

Shifting, leaking

An implant has a small risk of riding up the chest, so you may have to massage it down into place.

Occasionally, implants leak fluid. The chance of your breast implant leaking increases over time. Most implants that have been in place for 10–15 years have some leakage, but it's usually insignificant.

You may be able to tell if your implant leaks, because your breast may get smaller. A small leak of a saline implant can't be detected. Leaking saline is harmless.

Even a small leak of a silicone implant can show up on an MRI (magnetic resonance imaging) scan, or sometimes on a regular X-ray. While this isn't necessarily dangerous, it can lead to complications that you'd rather avoid. If you suspect a silicone implant is leaking, have it checked and, if necessary, replaced.