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Breast Implants After Mastectomy

    • Breast reconstruction with breast implants

    • image showing a breast implant and how it fits behind the chest wallBreast implants are made of an outer shell of silicone-based plastic. Permanent implants are filled with saline (sterile water similar to our own body fluids) or with silicone. The saline filled implants feel firmer, while silicone feels more like natural breast tissue. Implants come in two basic shapes, round or teardrop. The size of the implant depends upon the amount of saline or silicone in the implant and is typically described by bra cup size.

    • How does it work?

    • Artificial breast implants are placed behind the pectoralis muscle in the chest. Usually, two or three surgeries are needed.

      During the initial surgery, a temporary tissue expander is placed under the pectoralis muscle. This can be done at the time of the mastectomy or any time afterwards. The tissue expander is a collapsed implant that can be filled with fluid (saline) over time through a "port" under the skin. Its purpose is to slowly stretch the muscle and skin to hold the permanent implant. Fluid is added to the expander every one to two weeks until the desired size is achieved. Once the chest wall is stretched sufficiently, a second surgery is performed.

      During the second surgery, the expander is removed and the permanent implant is inserted. The nipple and areola can be added through further outpatient procedures. Both the initial surgery to place the expander and the surgery to replace the expander with the permanent implant take about one to two hours.

    • Possible complications

      • Infection or fluid collection: as with any invasive surgery or procedure, you can develop an infection or collection of fluid (clear fluid or blood) at the implant shortly after surgery. These complications may require treatment with antibiotics or removal of the fluids, but rarely require the implant to be removed (if removed, the implant can usually be replaced at a later time).

      • Necrosis: the death of the tissue around the implant usually due to poor blood flow to the tissue after the operation. It rarely happens with breast implants and usually does not harm the woman. However, it may leave the breast feeling hard and may distort the look of the breast.

      • Capsular contracture: the development of scar tissue around the implant that distorts or changes the shape of the breast. If severe, the capsular contracture may be uncomfortable or painful. Capsular contractures can be corrected surgically by removing the scar tissue and replacing the implant, but they may re-occur.

      • Ruptures or leaks: although it doesn’t happen often, breast implants may leak or rupture, spilling the saline or silicone into the surrounding tissues. Leaking usually occurs due to injury, age of the implant or for unknown reasons. The implant must be replaced if leaking occurs. Breast implants may need to be replaced over time to prevent leakage.

      • Pain: any of the above situations can cause pain. Occasionally, women develop chronic pain following reconstruction that cannot be explained, but it can be treated.

      Surgery with implants compared with surgery with tissue flaps

      • Surgery time with implants is much shorter than reconstruction surgery using tissue flaps.

      • Breast implants only require incisions in the chest and not other parts of the body required during tissue flap reconstruction.

      • Muscle and fat tissue are not moved from another area of your body as they are during tissue flap reconstruction.

      • The shorter surgery time and less extensive initial surgery can make recovery easier with breast implants than with tissue flap reconstruction.

      • Breast implants offer a very realistic breast shape; however, some women find that implants do not feel like normal breast tissue.

      • The reconstructed breast may feel firmer and less resilient than the natural breast tissue.

      • The reconstructed breast will not droop like your natural breast.

      • The breast implant will not change size with weight fluctuations like your natural breast.

      • If you have one breast reconstructed, you may need additional surgery to your natural breast so that it matches the reconstructed breast.

      • The total amount of time required and number of surgeries needed to complete the reconstructive process may be longer with breast implants than with tissue flap reconstruction.

      More on Breast Reconstruction
      Making the decision for breast reconstruction
      When to have breast reconstruction
      How breast reconstruction works
      Autologous breast reconstruction