RECONSTRUCTION WITH IMPLANTS

General information

Surgery Duration: 2-3 hours

Average hospital stay: 3-5 days

Total recovery time: 3-4 weeks

When would I be able to move about, walk and drive? 

After about 3-4 weeks.

When would I be able to exercise again? 

After about 8 weeks.

Where will the scars be on my body? 

Scars will be located around your breast area.

Compression garments and bra?

A sports bra should be worn for about 2 weeks.

Will I need any additional procedures?

Almost always additional procedures to achieve symmetry of the other breast are needed. Most commonly they include breast augmentation, breast reduction, breast lift. 

Further along, minor procedures on the reconstructed breast (nipple reconstruction, areola tattoo, etc.) are usually considered.

How does the procedure look like?

Immediate reconstruction: the implant is inserted at the same time (during the same surgical procedure) as mastectomy. There needs to be enough soft tissue remaining after mastectomy to cover the implant, which is placed under your chest muscle after the breast tissue was removed.

Delayed - immediate reconstruction: in cases where a more substantial amount of tissue (skin, subcutaneous tissue) is removed during mastectomy a staged approached reconstruction is preferred. This means that a temporary device called a tissue expander is placed under the chest muscle during the same procedure as mastectomy is performed. A tissue expander is an implant, that functions similar to a balloon. It is gradually inflated by injecting saline water over time, which increases its volume,  causing the overlying skin to expand slowly. Saline injections are performed during routine follow- up visit in the outpatient clinic. After enough skin is gained (which usually takes from 3 to 6 months), a second surgery in general anesthesia takes place, usually 2-6 months after the last expander filling. During the second surgery, the tissue expander is exchanged for a permanent silicone implant. The second procedure takes approximately an hour, and the recovery time is shorter.

If you decide for breast reconstruction sometime after your mastectomy a pre-expansion with a tissue expander is the only way to gain enough skin for later implant insertion.

Drawbacks and complications

The most common complications and adverse outcomes after breast reconstruction with implants are capsular contracture (hardening of breast area around the implant), infection, implant extrusion and implant rupture. Other local complications include implant wrinkling, asymmetry, scarring, and pain. These complications often result in reoperation or implant removal.

The following is a list of local complications and adverse outcomes that occur in one percent or more of patients at any time after breast implant surgery. They are listed in alphabetical order—not in order of prevalence.

• Asymmetry— breasts are uneven in appearance in terms of size, shape or breast level
• Pain in or around the breast area
• Capsular contracture—hardening of the breast area around the implant
• Chest wall deformity— the chest wall or underlying rib cage appears deformed
• Deflation of the breast implant— material inside leaks from the breast implant often due to a valve leak, a tear or a cut in the implant shell
• Delayed wound healing
• Extrusion— the skin covering the implant breaks down, and the implant appears through the skin 
• Implant displacement or malposition— the implant is not in the correct position in the breast
• Implant palpability or visibility— the implant can be felt through the skin
• Implant visibility— the implant can be seen through the skin
• Implant wrinkling or rippling
• Infection— during breast implant surgery, wounds are contaminated with micro-organisms, such as bacteria or fungi, causing an inflammation
• Necrosis— the presence of dead skin or tissue around the breast
• Rupture of the breast implant— a tear or hole in the implant’s outer shell
• Scarring
• Seroma—the collection of fluid around the breast implant
• Skin rash
• Swollen or enlarged lymph nodes also called “lymphedema or lymphadenopathy."
•  Unsatisfactory appearance due to implant shape or size

If you experience any of the local complications listed above after breast implant surgery, you may need specific treatments, which include possible additional surgery.

Capsular Contracture

Capsular contracture is the hardening of the breast area around the implant. This hardening causes the tissue to tighten, which can be painful. Severe capsular contracture may require another surgery or implant removal. Capsular contracture, whether mild, moderate or severe, may occur more than once in the same implant.

Exchanging the implant

Breast implants are not lifetime devices. You may need to have one or more additional procedure over the course of your life due to any or combination of local complications. You may also need one or more surgeries to improve breast appearance if you are unsatisfied with the outcomes of the surgery aimed at correcting any local complications.

Implant removal

One type of surgery involves the surgical removal of your implants, which may or may not include implant replacement. As many as 40 percents of women who receive breast implants for breast reconstruction need to have them removed within 8 -10 years. Over the course of your life, you may need to have your implant removed due to local complications. Many women have their implants replaced, while others do not experience any complications, avoiding the need of replacing them.

Implant rupture

Rupture is a tear or hole in the outer shell of the breast implant. When a silicone gel-filled implant ruptures, the gel may remain in the shell or in the scar tissue that forms around the implant (intracapsular rupture). In some cases, silicone gel may also escape from the scar tissue capsule around the implant and migrate away from the breast. When a silicone gel-filled breast implant ruptures, some women may notice decreased breast size, hard knots, rugged appearance of both breasts, local pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. However, most ruptures are without any symptoms. These are known as “silent ruptures.”

Magnetic Resonance Imaging (MRI) is the most effective way to detect silent rupture of a silicone gel-filled breast implant. It is recommended that women with silicone gel-filled breast implants undergo MRI screening three years after they receive a new implant and every two years after that for early detection of a silent rupture. Some breast implants rupture in the first few months after surgery and some later on, after several years.

Some possible causes of rupture include:

• Capsular contracture;
• Implant shell damage caused by surgical instruments;
• Damage during invasive procedures to the breast area, such as biopsies and fluid drainage;
• Normal aging of the implant;
• Physical stresses to the breast such as trauma or intense physical pressure;

It is recommended to remove breast implants if they have ruptured. You and your doctor will need to decide whether or not your implant has ruptured and whether you are a suitable candidate for autologous tissue reconstruction.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

BIA-ALCL is a type of T-cell lymphoma that can develop following breast implants. BIA-ALCL is not breast cancer. It is cancer involving cells of the immune system. BIA-ALCL is generally found in tissues around the implant itself and is usually contained within the fibrous capsule that the body forms around every implant. In some cases, it can spread throughout the body. Precise risks are difficult to determine due to lack of information about how many patients have received breast implants. Several recent publications have estimated an increased risk of developing BIA-ALCL in individuals with textured breast implants. The current literature reported various estimates that BIA-ALCL might develop in 1 in between 3,817 to 30,000 women with textured breast implants (FDA, 2017)

Most of the cases reported in the literature describe individuals who have had textured implants. Several recent journal articles explore possible risk factors for developing BIA-ALCL, including the methods used to create the textured surface and the role of biofilm. Most of the breast implant patients found to have BIA-ALCL were diagnosed after they sought medical treatment for implant-related symptoms such as pain, lumps, swelling, or asymmetry that developed after their initial surgical sites have fully healed. In most cases, the BIA-ALCL was treated with surgery to remove the implant and surrounding scar tissue. Some patients also received additional radiation therapy, chemotherapy or both.

The risk of developing BIA-ALCL is low. If you have breast implants, there is no need to change your routine medical care and follow-up. You should expect swelling and pain immediately after surgery. If you notice changes in the way your breast looks or feels after your recovery from surgery has been completed—including swelling or pain around the implant—be sure to talk to your healthcare provider about the possibility of BIA-ALCL.

Connective Tissue Disease

The FDA has not detected any association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. Studies would need to be larger and longer than these conducted so far to rule this and other complications out definitively.