Implants - Living With Breast Cancer And Its Treatments: Breast Cancer

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Implants

A saline implant is a silicon bag filled with salt water (saline). An implant procedure is a less complicated surgery than other surgical breast reconstructions and offers a satisfactory result for a woman with small or medium-sized breasts who has had a mastectomy. The plastic surgeon will first insert an expander underneath your chest wall muscle several months before the implant insertion. Once every two to four weeks, for a period of months, saline will be injected into the expander so it gradually enlarges, slowly stretching the overlying chest wall muscles. When your skin and muscle have stretched enough to match the other breast, the expander will be removed during a second operation and replaced with a permanent saline implant (see Figure 7). Women with very small breasts might be able to have a permanent implant right away, without the expansion procedure.

To recreate a large breast with this method is difficult; to achieve a match, it may be necessary to reduce the remaining breast. Tissue expansion often is not feasible in women who've had chest wall radiation therapy, because radiation sometimes stiffens the chest wall muscle under which the implant is placed.

Figure 7: Reconstruction with implant The surgeon removes all of the breast tissue but preserves as much of the breast skin as possible to allow for reconstruction with a breast implant. Usually the plastic surgeon first inserts an expander under the muscles of the chest wall to stretch the muscles in preparation for the implant. Once the muscles have stretched sufficiently, the expander is removed and replaced with a permanent implant.

Saline implants have some negative aspects. They are firmer than natural breast tissue; the upper part may ripple when you are upright; they may slip out of place; and they may leak. Your body will gradually form a fibrous capsule around your breast implant. In most women the capsule stays soft and pliable; in others, however, the capsule becomes thickened and stiff, and the breast feels hard. If this occurs, the capsule is surgically removed and the implant is replaced, but usually the hardening occurs again and you must either live with it or replace the implant with a tissue reconstruction.

Among women who participated in a three-year study, the FDA identified a variety of problems associated with implants, including asymmetry, wrinkling, leaking or deflation of the implant, loss of nipple sensation, and the need for additional surgeries or implant removal. Some women experienced more than one of these complications. Keep in mind that it may take more than one surgery to achieve the desired results. Breast implants are not expected to last a lifetime. You are likely to need surgery to replace the implant at some point in your life.

In 1991, the FDA banned silicone implants, which were commonly used for breast enhancement as well as reconstruction, because of reports possibly linking them to several chronic diseases. Since then, these implants have been available only to women being treated for breast cancer who are undergoing breast reconstruction and who agree to be part of a clinical trial. Up until recently, women need to be part of a clinical trial to obtain silicone implants (2004). However, in late 2006, after much evaluation and follow-up of clinical data, the FDA approved silicone breast implants 14 years after their initial withdrawal.

Implant procedures are available either as outpatient surgery or with an overnight hospital stay. Recovery is fairly rapid. Reconstruction surgeries using your own tissue may require about two to five days of hospitalization and a healing period of at least six weeks. Wounds may heal more slowly in some women, particularly those who smoke, who have diabetes, or who have previously undergone radiation. There will be scars where tissue was removed; most eventually fade. Reconstruction doesn't restore normal sensation to your breast, although some feeling may return.

Created by the Faculty of the Harvard Medical School

Copyright Harvard Medical School, Harvard University, 2007

Last updated:	April 23, 2007