A breast implant is a round or tear-shaped sac made of rubberized silicone. It is filled with saline (sterile salt water) or silicone gel. Breast implants that are made of or filled with other materials are considered experimental.
Women considering breast reconstruction with implants should discuss the risks and benefits of saline and silicone breast implants with their doctor.
Some women may have concerns about silicone breast implants. Scientific reviews have found no proven link between breast implants and autoimmune or other systemic diseases. In Canada, manufacturers of breast implants filled with silicone gel must take measures to identify any risks associated with the implants, and eliminate or reduce these risks as much as possible. They must also provide enough information to healthcare professionals and women about all known risks.
Women with larger breasts may need surgery on the other (unaffected) breast to balance the appearance of their breasts.
A breast implant used in breast reconstruction is placed in a natural pocket under the chest muscle.
If the skin and chest wall tissues are tight and flat, tissue expansion may need to be done before a breast implant can be placed.
An expander implant is an empty bag with a small valve, like a balloon. It is placed under the skin and muscle of the chest wall. A very small needle inserted through the skin and into the valve is used to inject small amounts of saline into the expander implant. This is done every 1–2 weeks in the doctor’s office until the skin is stretched enough to fit a breast implant that would match the size of the opposite breast. This may take up to 3 months.
After the skin has stretched enough, a second operation is done to remove the expander implant and place a more permanent implant. Sometimes, the expander implant is left in place as the final implant.
One-step reconstruction (or direct to implant reconstruction) is a newer procedure that may be an option for some women. It is done using special donated human skin tissue, called acellular dermal matrix (AlloDerm, DermMatrix). The cells are removed from the donated tissue to prevent rejection.
Instead of several weeks to expand the pocket for the implant, the reconstructive surgeon stitches strips of the acellular dermal matrix to the breast tissue to create a pocket for the implant. Acellular dermal matrix may also be used to cover the edges of an implant. Over time, the acellular dermal matrix grows into a woman’s healthy breast tissue.
One-step reconstruction using acellular dermal matrix is not widely available in Canada.
Potential side effects
Surgery to place a breast implant carries the same general risks as other surgical procedures. There may be a higher number of complications in women who have had radiation therapy to the chest.
Side effects can happen any time during surgery for breast reconstruction. Some may happen during, immediately after, or a few days or weeks after surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent.
It is important to report side effects to the healthcare team.
Some possible side effects of breast implant surgery include:
- infection – often occurs right after surgery
- buildup of fluid (seroma)
- pain or soreness – often for 1–2 weeks after surgery
- capsular contracture
- Scar tissue forms around the breast implant, making the breast feel hard and lose its shape.
- the implant moves or shifts position
- the implant wrinkles, causing the skin of the breast to wrinkle
- the implant leaks or tears
Removal of a breast implant
Breast implants are usually not left in place for a woman’s lifetime and at some point may have to be removed. Removing a breast implant may cause dimpling, puckering, wrinkling or other changes to the appearance of the breast. The woman should talk to her surgeon before she decides whether or not to have the breast implant replaced.
Mammography and breast implants
A woman who has breast reconstruction with an implant after breast cancer should ask her surgeon whether mammography of the reconstructed breast is necessary.
- If mammography is recommended, special techniques are used to do the procedure.
- An ultrasound or magnetic resonance imaging (MRI) of the breast may also be done.
- MRI cannot be used for tissue expanders that have a metal port or plate.
A woman needs to continue to have regularly scheduled mammography on the other (unaffected) breast.
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