What you need to know about implants after breast surgery

Part of my job as a reconstructive plastic surgeon is to educate women about breast reconstruction. I firmly believe that all women with breast cancer should know their options. Many women are unaware of the wide range of breast reconstruction options available, and fewer women are not aware that the timing of the decision to undergo reconstruction can have a significant impact on their choices and outcomes.

Although there are many techniques, many women choose implant-based reconstruction. Almost everyone has heard of breast implants, but it is important to recognize the differences between cosmetic breast augmentation and breast reconstruction after a mastectomy. Specifically, it is easy to achieve consistently positive cosmetic results with breast augmentation. Single-stage breast implant reconstruction may be possible in some women, but many women need a temporary tissue expander, using an adjustable saline-filled implant.

The following features help surgeons choose the best implant that suits their individual needs:

Fill: Saline implants can be filled with varying amounts of sterile saline. If the crust leaks, the implant collapses and releases saline into the body. In general, these implants have more noticeable ripples under the thinner skin. Silicone gel is similar to natural breast tissue, but implant ruptures can be more difficult to detect and require an ultrasound/MRI scan. Current 4th and 5th generation implants that contain “high-adherence silicone gel” are slightly stiffer and are known as “gummy bear implants”.

Shape : Round implants have a rounded base and varying degrees of projection (how much they protrude from the chest), providing more fullness to the upper chest. Some older generation round implants are not filled and more ripples may appear in the vertical position. In recent years, implants with a stable shape have become available and popular due to their ability to mimic the natural shape of the breast. They come with little risk of abnormal rotation, but surgical techniques have been modified to fit a hand glove.

Texture: Smooth breast implants move freely within the breast capsule, but may be more wavy. Woven implants allow tissue to adhere to the implant, making it less likely to set or rotate abnormally.

Size: Breast implants are now available in various combinations of dimensions (base width, base height, projection, etc.), resulting in a wide range of sizes to suit customized needs. It is common practice to place different sized implants in each breast to improve symmetry. The implants weigh about 1 ounce per 30 cubic centimeters of volume. Size does not translate accurately to bra cup size, so frequent communication with your plastic surgeon is critical to setting appropriate expectations.

Many women ask about the safety and longevity of breast implants. The Institute of Medicine and several large studies have concluded that silicone implants are not responsible for major diseases throughout the body. Research has not supported concerns that women who use breast implants are more likely to develop new or recurrent breast cancer. Mammography can be examined after breast augmentation, but requires additional views for imaging examination. Most importantly, breast implants should not be expected to last a lifetime. Duration varies from woman to woman, and replacement is often ordered by selection due to asymmetry, changes in size or style preferences. Some women need to have a breast implant replaced or switch to a different type of breast reconstruction due to implant complications, such as tearing or induration caused by scar tissue.

At the end of the day, no matter what patients choose, they should be aware that breast reconstruction depends on understanding and feedback, so open and frequent communication with surgeons is especially important.

Learn more about breast cancer surgery.