Breast Implant Reconstruction

Breast reconstruction using a breast implant or an expander (an inflatable implant) involves the placement of the prosthesis (the name given to any type of implant) under the muscle of the chest to create a new breast. This may be accompanied by a synthetic or biological supportive mesh in the lower part of the breast. Breast reconstruction using an implant alone is not usually a suitable method for reconstruction if you have had chest wall radiotherapy in most cases.

What does it involve?

A breast implant or expander is inserted either at the time of mastectomy through the mastectomy incision, or alternatively at a later date, often through a separate incision in the crease under the breast. An expander implant has a tube connecting the implant with a small valve which is placed under the skin below the bra line. From around 2-3 weeks after the surgery, it is necessary to attend the outpatient clinic on a regular basis (fortnightly) for inflation of the expander with saline. This is done by injecting the valve through the skin. This process will continue until the desired size of new breast has been reached.

What are the benefits?

This is the simplest method of breast reconstruction with the fastest recovery. The goal of this method of reconstruction is to make a breast mound that looks good in clothing – it will never behave or feel like a natural breast as the reconstruction is purely made up of the silicone implant.

How long does the surgery take?

The surgery takes around 1-1.5 hours. You will have a surgical drain placed at the time of surgery, which will be removed a few days after the operation, whilst in hospital.

What is the recovery period?

You will stay in hospital for 4-5 days, but it will probably take you 6-weeks until you have recovered completely.

How long before daily activities may be resumed?

You will be able to resume all regular activities by 6-weeks. You should be able to drive by 3-weeks.

What are the success rates?

The overall success rate of this procedure is very high. The main problems relate to capsular contracture (tightening of the naturally-forming scar tissue around the implant that may change the shape of the breast reconstruction or cause discomfort). This would necessitate further surgery to replace the implant and release the tight scar tissue.

What are the possible complications?

Other complications include those related to having a breast implant and general complications from surgery: wound infection or breakdown – if significant this may require a further operation to remove the breast implant which may then be re- inserted after a 3-6 month break; implant extrusion (a rare complication where the pressure from the expander causes it to appear through the skin, necessitating an operation to remove it); seroma (accumulation of fluid); bleeding (requiring transfusion or occasionally return to surgery); lumpy scarring in some people; a small risk of blood clots in the legs (DVTs) that may go to the lungs (PEs) and chest infections.