Breast reconstruction using an implant

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1 Breast reconstruction using an implant This information is from the booklet Understanding breast reconstruction. You may find the full booklet helpful. We can send you a free copy see page 10. Contents Reconstruction using a breast implant One-stage procedure Two-stage procedure Who is implant reconstruction suitable for? Benefits of implant reconstruction Limitations of implant reconstruction Risks of implant reconstruction Reconstruction using a breast implant Breast implants are often used for immediate breast reconstruction and for women who are having both breasts reconstructed. The surgeon creates a new breast shape by putting a breast implant under the chest muscle. Breast implants are made of a silicone outer cover with either silicone gel or salt water (saline) inside. They come in a range of sizes and can be round or teardrop-shaped. Reconstruction using an implant can be a one-stage or twostage procedure. We explain these two procedures over the next pages. One-stage procedure In a one-stage procedure, the surgeon puts either a fixed-size implant or an expandable implant under your chest muscle. Questions about cancer? Ask Macmillan Page 1 of 10

2 Fixed-size implant The surgeon puts a permanent silicone implant behind the muscle to create a breast shape. Sometimes they use a material called acellular dermal matrix (ADM) to support the implant. ADM is a tissue-like substance made from pig skin, cow skin or other natural substances. The surgeon attaches the ADM to the chest muscle and the chest wall to create a sling. This holds the lower part of the implant in place. It also helps give the breast a natural droop without tissue expansion to stretch the chest muscle. Your surgeon can explain the possible advantages and disadvantages of ADM. Some surgeons use a synthetic mesh instead of ADM as a sling to support the implant. Expandable implant If your chest muscle needs to be stretched, the surgeon can use an expandable implant. It has an outer chamber of silicone gel and a hollow inner chamber that can be filled with saline through a valve (port). The surgeon puts the expandable implant under your chest muscle. Then after a few weeks when the tissues have healed, the process of stretching the muscle and skin to form your new breast shape begins. Every 1 2 weeks, a nurse or doctor injects saline into the implant. They do this through a port under the skin of your underarm. You may feel some aching or tightness in the breast area for a day or two after each injection. This process continues over several weeks. After a few more weeks, once the muscle has been stretched, the nurse or doctor may remove some saline through the port. Slightly overstretching the muscle can help give the reconstructed breast a more natural appearance. The surgeon can then take the port out during a small operation under a local or general anaesthetic. Page 2 of 10 Questions about cancer? Ask Macmillan

3 Yesterday I went to have some of the saline taken out. That makes them a little bit smaller the size I want now. They are softer, like they were before. The recovery was good. I m very pleased with the results. Harjinder, who had expandable implants in both breasts Two-stage procedure In a two-stage procedure, the surgeon puts a temporary tissue expander under the chest muscle to stretch it. A temporary tissue expander has a hollow inner chamber that can be filled with saline, but it doesn t have the silicone gel outer chamber that a permanent expandable implant has. A temporary tissue expander in the breast Chest muscle Valve (port) Expandable implant Rib Using a butterfly needle, a nurse or doctor injects saline into the expander through a port just under the skin of the chest. This increases its size and stretches the chest muscle to form the breast shape. Questions about cancer? Ask Macmillan Page 3 of 10

4 Saline is injected into the implant through a butterfly needle Butterfly needle Expandable implant that has been injected with saline to stretch the chest muscle Once the temporary implant has expanded to its final size, it stays in place for a few months to allow the muscle to stretch fully. You then have an operation to have the implant taken out and a permanent silicone implant put under your chest muscle. This gives you your final breast shape. Page 4 of 10 Questions about cancer? Ask Macmillan

5 The expandable implant is removed and a permanent silicone implant is put in its place Permanent silicone implant Both these women have had reconstruction of both breasts with expandable implants. The photo on the right also shows nipple reconstruction (see our Understanding breast reconstruction booklet) Questions about cancer? Ask Macmillan Page 5 of 10

6 Double (bilateral) mastectomy followed by breast reconstruction using implants (without nipple reconstruction) Who is implant reconstruction suitable for? Implants may be suitable for women who: are younger and have smaller breasts are having surgery to reconstruct both breasts at the same time may not be fit enough for longer operations don t want surgery to other parts of their body. Implants are not usually suitable for women who have: concerns about implants had radiotherapy to the chest larger breasts. Benefits of implant reconstruction Having an implant put into the breast is a simple operation. It has a slightly shorter recovery time than other types of reconstruction. Implant reconstruction leaves less scarring on the breast and no scars elsewhere on your body. The breast outline can look balanced in clothes. It can give a good appearance, particularly for women with small breasts or women who are having both breasts reconstructed. Page 6 of 10 Questions about cancer? Ask Macmillan

7 Limitations of implant reconstruction You may need several visits to the hospital over a few months for tissue expansion. The operation will leave a scar. Implants don t feel as soft or as warm as a breast that s formed using your own tissue. The reconstructed breast may not have the same droop as the natural breast. To get the best result, you usually need further operations. These are to reposition the implant or to add fat over the implant (lipomodelling see our booklet Understanding breast reconstruction) to improve the shape and give a more natural feel. The implant can change shape slightly when the muscle over it tightens (contracts) during some movements. Some women may be able to see a rippling effect through their skin. This is caused by creasing or folds in the implant. This can be improved with lipomodelling. A reconstructed breast has less sensation than the original breast. It may feel numb. Your natural breast changes over time, but the breast with the implant won t. In the future you may need more surgery to keep your breasts balanced. If the implant leaks (ruptures) or if the tissue around the implant tightens (capsular contracture see page 8), you may need surgery to replace the implant. This is much more common if you have radiotherapy. Risks of implant reconstruction After any operation, there is a risk of wound infection, bleeding, pain and bruising. You can read more about this in our booklet Understanding breast reconstruction. There are also some issues that are specific to implants. We list these over the next few pages. Up to 1 in 10 women (10%) who have an implant need to have it taken out within the first three months of surgery. Smoking or having radiotherapy increase the risk of this happening. Questions about cancer? Ask Macmillan Page 7 of 10

8 Infection around the implant It s not common to have an infection in the tissue around the implant. But if this happens, the implant usually has to be removed until the infection goes. The implant can then be replaced a few months later with a new one. You ll be given antibiotics at the time of your operation to reduce the risk of infection. Follow any advice you are given about preventing infection. If an implant needs to be removed due to infection, the final appearance of the reconstructed breast may not be as good. Tightening or hardening of tissue around the implant (capsular contracture) A breast implant is not a natural part of you, so your body tries to keep it separate. It does this by forming a capsule of scar tissue around the implant. Over a few months, the scar tissue shrinks (contracts) as part of the natural healing process. In some women, the capsule can become very tight. This is called capsular contracture. Smoking, infection and radiotherapy increase the risk of it happening. Capsular contracture can make the breast feel hard or painful, or make it change shape. Some women who have capsular contracture need to have an operation to remove the implant and replace it with a new one. Or they might have an operation to have fat from another part of their body injected around the implant (lipomodelling). Damage (rupture) to implants It is very difficult to damage implants. It s fine to continue with your normal activities, including sports and air travel, without worrying that it will affect your implant. However, sometimes implants can split or tear. Most silicone implants contain a firm gel that is very unlikely to leak much, even if the outer covering is damaged. Saline-filled implants aren t commonly used in the UK. They are more likely to leak and don t look or feel as natural as silicone implants. If saline leaks out of an expander device (see pages 3 4), it won t cause any harm but the implant will go flat and will need to be replaced. Page 8 of 10 Questions about cancer? Ask Macmillan

9 Safety of silicone breast implants There has been a lot of research looking into whether silicone implants cause health problems. No link has been found between silicone implants and the development of cancer or other conditions. Recently there have been concerns about the quality of the silicone used to fill breast implants. This happened because French-made PIP breast implants were found to contain industrial- rather than medical-grade silicone filler. PIP implants have not been used in the UK since Breast implants used in the UK must be approved by the Medicines and Healthcare Products Regulatory Agency (MHRA). This organisation is responsible for ensuring that medical devices, including breast implants, are safe and fit for use. If you re concerned about having breast implants, it s important to discuss this with your surgeon before your operation. They will be able to tell you what type of implants you will have and who makes them. Implants and mammograms Implants can make mammograms (breast x-rays) more difficult to read. If you have had a mastectomy, you won t need to have mammograms of the reconstructed breast. But if you have an implant put in after breast-conserving surgery or an implant put into your natural breast to balance it with the reconstructed breast, you should continue to have regular mammograms of this breast. It s important to tell the person doing the mammogram that you have an implant. This is so they can use the most appropriate screening method for you. Questions about cancer? Ask Macmillan Page 9 of 10

10 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding breast reconstruction or any other cancer information, visit be.macmillan.org. uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN June 2015 Planned review in 2017 Page 10 of 10 Questions about cancer? Ask Macmillan

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