After a mastectomy, Dr. Rancati may reconstruct the breast with an implant, a round and flexible silicone shell filled with either saline or silicone gel. Breast implants can be placed over the chest muscle or underneath part or all of the chest muscle to replace the breast tissue removed during the mastectomy. This restores the shape and volume of the breast.

What is a Breast Reconstruction With Implants?

Of the more than 107,000 breast reconstruction procedures in the United States in 2019, about 80% of them used implants.

The other popular type of breast reconstruction, autologous or “flap” surgery, uses tissue transplanted from another body site to form a breast shape. More plastic surgeons have experience with breast implant surgery than with flap reconstruction.

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Candidates for Breast Reconstruction With Implants

You may be a good candidate for breast reconstruction with implants if:

  • After the mastectomy, you have sufficient healthy skin and tissue to cover and support a breast implant
  • You want to avoid the incisions and scars on other parts of your body associated with flap reconstruction
  • You can’t or don’t want to have the more extended surgery and recovery time needed for flap reconstruction
  • You do not need radiation therapy; there is a significantly high chance of developing problems with implant reconstruction after radiation treatment.

How do I prepare for breast reconstruction with implants? What should I expect?

Before a mastectomy, ensure that the breast reconstruction surgeon you choose has experience with the types of reconstruction you are considering and will discuss the advantages and disadvantages of your options.

If radiation therapy is part of your breast cancer treatment plan, you’ll likely need a plastic surgeon specializing in flap reconstruction because radiation can lead to complications with implants. Additionally, suppose you’re having immediate breast reconstruction at the same time as the mastectomy surgery. In that case, you must choose a plastic surgeon who does surgery at the same hospital as your breast surgeon so they can work together as a team.

Breast reconstruction with implants begins by placing a breast implant in front of the muscle. These are held in place using a particular tissue called an acellular dermal matrix, which your body replaces with collagen over time, either at the time of your mastectomy or during a later procedure.

While some women can have the permanent breast implant placed at the time of the mastectomy, many others require a two-stage process that uses a tissue expander before the permanent implant is placed.

After the tissue is adequately expanded, your surgeon performs a second surgery to remove the tissue expander and replace it with a permanent implant in the exact location of the tissue expander.

Recovery, results, and when to expect them

The breast implant reconstruction process frequently involves two or more surgical procedures over six months to one year. Before and after each surgery, you’ll need to follow your medical team’s specific instructions, such as the special exercises you should do to minimize stiffness and scar tissue build-up after immediate breast reconstruction.

It can take up to eight weeks to recover from implant reconstruction surgery simultaneously with the mastectomy. If you have tissue expanders placed during your initial surgery, you will have another surgery to swap the expanders for breast implants, generally between two and six months later.

In terms of results, breast reconstruction with implants can give you an excellent cosmetic effect but may not have the same look or feel as your original breasts. Some other results to consider are:

  • Most women lose sensation in their breast area after a mastectomy
  • If you’re having a mastectomy and implant reconstruction on only one breast, your breasts may not be symmetrical after surgery
  • You can choose to surgically alter your healthy breast so it will better match the reconstructed breast in size and shape
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Your reconstructed breasts will have healed and settled into a final position in four to six months after your last implant reconstruction surgery. After, you might decide to have other procedures to improve the results, such as:

  • Nipple reconstruction
  • Nipple tattooing
  • A procedure to address asymmetry if you only had one breast reconstructed
  • Scar revision surgery to visibly reduce the appearance of breast surgery scars
  • Corrective surgery to fix a complication associated with breast reconstruction

You may also consider fat grafting to:

  • Fill in imperfections or add volume to the reconstructed breast
  • Soften and improve skin affected by radiation therapy
  • Thicken the layer of tissue between an implant and the skin
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Any Risks or Side Effects

Before deciding whether to get breast implant reconstruction, ensure you understand the risks and benefits and how to care for breast implants over time. Here are some things to keep in mind:

  • Your breast implant will not last a lifetime. Women with implant reconstruction usually have one or more additional surgeries to remedy a complication or improve their breasts' look and feel.
  • The FDA recommends that your breast surgeon or plastic surgeon screens your implants for rupture and other issues, beginning 5 to 6 years after the implant is placed and repeating every 2 to 3 years. Your insurance may not cover these imaging tests, so ask your surgeon if they will work with your insurance company to cover them in advance.
  • See a healthcare provider immediately if you notice abnormal changes in your breasts or implants.

Possible complications that can occur after implant reconstruction include:

  • Capsular contracture can cause pain and distort the shape of the breast.
  • Implant rupture
  • Implant displacement
  • Breast implant illness (BII) has a range of symptoms, such as rashes and joint and muscle pain that can develop after implant reconstruction
  • Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of immune system cancer that can develop in the scar tissue capsule and fluid surrounding an implant

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