Implants

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Types of implants

The most common breast implant is a saline-filled implant – a silicone shell filled with salt water (sterile saline).

Silicone gel-filled implants are also an option for breast reconstruction. The first silicone implant was used in 1962, and the first saline implant was used shortly after, in 1964. After initial concerns about these implants, most studies show that silicone implants do not increase the risk of medical problems, and they have been approved for use since 2006.

The newest type of “Gummy Bear” implants, form-stable implants, use thicker silicone gel, called cohesive gel. The thickest ones are made of highly cohesive silicone. They keep their shape even if the cover is cut. Form-stable implants were approved in early 2013 in the U.S., but their safety is still being evaluated. Alternative breast implants are being studied and are available only in clinical trials.

Implant surgery types

One-stage immediate breast reconstruction may be done at the same time as the mastectomy. After your surgeon removes the breast tissue, a plastic surgeon places a breast implant. The implant is usually placed in the space created where the breast tissue was removed, but extra support is often needed. Sometimes the surgeon will stitch in a special type of graft or an absorbable mesh to hold the implant in place.Note that breast surgeons can also place the implants without a plastic surgeon, if necessary.

Two-stage reconstruction or two-stage delayed reconstruction is usually preferred if implants are used. If your skin and chest wall tissues are tight and flat, it is a simpler procedure. A tissue expander, which is like a balloon, is placed under the skin and chest muscle. Through a tiny valve under the skin, the surgeon injects a salt-water solution at regular intervals to fill the expander over a period of about four to six months. After the skin over the breast area has stretched enough, you will undergo a second surgery during which the expander is removed and the permanent implant is put in.

The two-stage reconstruction is sometimes called delayed-immediate reconstruction because it allows time for other treatment options. If other options are not needed, the surgeon can start right away with the tissue expander and second surgery.

Considerations

If you are thinking about having implants to restore the breast and/or to make the other breast match the restored one, consider and discuss these factors with your doctor:

• Implants often do not last a lifetime. You may need additional surgery to remove and/or replace the implant later. Implants normally have a 10 year shelf life which may require more surgery in the future.
• Breast implants may cause problems. Implants can rupture, cause infection and/or pain. Scar tissue may form around the implant, which can make your breast harden or change shape. Some of these problems may not be reversible, even through surgery.
• MRIs may be needed every few years to ensure that silicone gel implants have not leaked. Your health insurance may not cover these tests.
• Mammograms to screen the remaining breast for breast cancer can be more difficult if you have a breast implant.
• Breast implants may affect your ability to breastfeed.