Breast reconstruction - implants
After a mastectomy, some women choose to have cosmetic surgery to recreate their breast. This surgery can be performed during mastectomy itself or later.
The breast is usually reshaped in two stages, or surgeries. During the first stage, a tissue expander is used. An implant is placed during the second stage. Sometimes the implant is inserted in the first stage.
Breast implants surgery
If you are having reconstruction at the same time as your mastectomy, your surgeon may do a skin-sparing mastectomy. This means only the area around your nipple and areola is removed and skin is left to make reconstruction easier.
If you will have breast reconstruction later, your surgeon will remove enough skin over your breast during the mastectomy to be able to close the skin flaps.
Breast reconstruction with implants is usually done in two stages, or surgeries. During the surgeries, you will receive general anesthesia (asleep and pain-free).
In the first stage:
- The surgeon creates a pouch under your chest muscle.
- A small tissue expander is placed in the pouch. The expander is balloon-like and made of silicone.
- A valve is placed below the skin of the breast. The valve is connected by a tube to the expander. (The tube stays below the skin in your breast area.)
- Your chest still looks flat right after this surgery.
- Starting about 2 to 3 weeks after surgery, you see your surgeon every 1 or 2 weeks. During these visits, your surgeon injects a small amount of saline (salt water) through the valve into the expander.
- Over time, the expander slowly enlarges the pouch in your chest to the right size for the surgeon to place an implant.
- When it reaches the right size, you will wait 1 to 3 months before the permanent breast implant is placed during the second stage.
In the second stage:
- The surgeon removes the tissue expander from your chest and replaces it with a breast implant. This surgery takes 1 to 2 hours.
- Before this surgery, you will have talked with your surgeon about the different kinds of breast implants. Implants may be filled with either saline or a silicone gel.
You may have another minor procedure later that remakes the nipple and areola area.
Why the Procedure Is Performed
You and your doctor will decide together about whether to have breast reconstruction, and when to have it.
Having breast reconstruction does not make it harder to find a tumor if your breast cancer comes back.
Getting breast implants does not take as long as breast reconstruction (which uses your own tissue). You will also have fewer scars. The size, fullness, and shape of the new breasts are more natural with reconstruction that uses your own tissue.
Many women choose not to have breast reconstruction or implants. They may use a prosthesis (an artificial breast) in their bra that gives them a natural shape, or they may choose to use nothing at all.
Women who have had a lumpectomy rarely need to have breast reconstruction.
Risks of any surgery are:
- Blood clots in the legs that may travel to the lungs
- Blood loss
- Breathing problems
- Heart attack or stroke during surgery
- Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
- Reactions to medicines
Risks of breast reconstruction with implants are:
- The implant may break or leak in the first 10 years. If this happens, you will need more surgery.
- A scar may form around the implant in your breast. If the scar becomes tight, your breast may feel hard and cause pain or discomfort. This is called capsular contracture. You will need more surgery if this happens.
- Infection soon after surgery. You would need to have the expander or the implant removed.
- Breast implants can shift. This will cause a change in the shape of your breast.
- One breast may be larger than the other (asymmetry of the breasts).
- You may have a loss of sensation around the nipple and areola.
Before the Procedure
Tell your surgeon if you are taking any drugs, supplements, or herbs you bought without a prescription.
During the week before your surgery:
- Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and other drugs like these.
- Ask your surgeon which drugs you should still take on the day of surgery.
On the day of your surgery:
- Follow your surgeon's instructions about not eating or drinking.
- Take the drugs your surgeon told you to take with a small sip of water.
- Shower the night before or the morning of surgery.
- Arrive at the hospital on time.
After the Procedure
You may be able to go home the same day as the surgery. Or you will need to stay in the hospital overnight.
Results of this surgery are usually very good. It is nearly impossible to make a reconstructed breast look exactly the same as the remaining natural breast. You may need more "touch up" procedures to get the result you want.
Reconstruction will not restore normal sensation to the breast or the new nipple.
Having cosmetic surgery after breast cancer can improve your sense of well-being and your quality of life.
McGrath, MH, Pomerantz J. Plastic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 69.
Roehl KR, Wilhelmi BJ, Phillips LG. Breast reconstruction. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 37.