Breast reconstruction using an implant after risk-reducing surgery This information is from the booklet Understanding riskreducing breast surgery. You may find the full booklet helpful. We can send you a free copy see page 9. Contents What are breast implants? One-stage procedure Two-stage procedure Benefits of implant reconstruction Limitations of implant reconstruction Risks of implant reconstruction What are breast implants? Breast implants are often used for immediate breast reconstruction and for women who are having both breasts reconstructed. The surgeon creates new breast shapes 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. 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 0808 808 00 00 www.macmillan.org.uk Page 1 of 9
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 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Two-stage procedure 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 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 0808 808 00 00 www.macmillan.org.uk Page 3 of 9
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 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
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. We have more information about nipple reconstruction. Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 5 of 9
Double (bilateral) mastectomy followed by breast reconstruction using implants (without nipple reconstruction) Benefits of implant reconstruction It is a simpler operation than other types of breast reconstruction and has a slightly shorter recovery time. It leaves less scarring on the breast and no scars elsewhere on your body. It can give a good appearance, particularly for women with small breasts. Limitations of implant reconstruction You may need several visits to the hospital for tissue expansion. The operation will leave a scar on both breasts. Implants don t feel as soft or as warm as breasts made using your own tissue. The implants can change shape slightly when the muscle over them tightens (contracts) during some movements. Some women may be able to see a rippling effect through their skin caused by creasing or folds in the implants. This can be improved by injecting fat over the implants (lipomodelling). We have more information about this in Understanding risk-reducing breast surgery. Page 6 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
Reconstructed breasts have less sensation than natural breasts. They may feel numb. You may need surgery to replace implants if they leak (rupture) or cause tightening of the tissue around the implant (capsular contracture). Risks of implant reconstruction After any operation, there is a risk of wound infection, bleeding, pain and bruising. You can read more about these in our booklet Understanding risk-reducing breast surgery. There are also some issues specific to implants: Removal of implant Up to 1 in 10 women (10%) who have breast implant reconstruction need to have an implant taken out within the first three months of surgery. Smoking increases the risk of this happening. 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 clears. The implant can then be replaced with a new one. You ll be given antibiotics at the time of your operation to reduce the risk of infection. If an implant needs to be removed due to infection, the final appearance of the reconstructed breast may not be as good. Follow any advice you are given about preventing infection. For ages my implants felt like I had beanbags stuck to my chest. They do eventually begin to feel part of you I can t remember now what my old boobs felt like! You go through a lot of feelings numbness, random pains, they will be swollen one day and then look different the next, but things do calm down. Vicki Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 7 of 9
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 and infection increase the risk of capsular contracture. Capsular contracture can make the breast feel hard or painful, or make it change shape. Some women need an operation to remove the implant and replace it with a new one, or to have fat from another part of their body injected around the implant (lipomodelling). Rippling of implants The surgeon places each implant under a chest muscle. But this is often very thin, so implants are close to the skin. If an implant creases as you move, you may see this as rippling under the skin. Your surgeon may suggest injecting fat under the skin (lipomodelling) to reduce the appearance of rippling. 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 implants. However, occasionally implants can split or tear. Most silicone implants contain a firm gel that is very unlikely to leak in significant amounts, even if the outer cover is damaged. If saline leaks out of an expander device, it won t cause any harm but the implant will go flat and need to be replaced. Page 8 of 9 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk
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 2010. 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. 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 risk-reducing breast surgery or any other cancer information, visit be.macmillan.org.uk or call 0808 808 00 00. 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 2013. 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 AUGUST 2015 Planned review in 2018 Questions about cancer? Ask Macmillan 0808 808 00 00 www.macmillan.org.uk Page 9 of 9