Breast Implants

Breast Reconstruction with Breast Implants

Reconstruction with breast implants involves restoring the form of the breast by inserting, into the mastectomy site, a breast prosthesis made of synthetic material. Implants come in a variety of shapes and sizes; they have an outer shell made from silicone that is filled with either saline or silicone gel. Although there has been considerable concern over the safety of silicone-gel filled implants, their use is currently approved by the U.S. FDA.

While implant reconstructions generally require the shortest initial hospitalization of all the possible methods of breast reconstruction—and some women find implant reconstructions appealing for this and other reasons—many patients and many doctors are troubled by the high rate of unplanned re-operation associated with this method of reconstruction. Unfortunately, common consequences of implant reconstruction include re-operation and the need to remove implants, according to the U.S. Food and Drug Administration. Large studies of women who had breast reconstruction using implants have found that:

• Approximately 40% of women will require unplanned re-operation within 5 years, and approximately 50% will require unplanned reoperation within 7 years
• One or more times over the course of the patient’s life, she will probably need to have her implants removed because of rupture or other complications

Complications & Limitations

Some of the more frequently occurring complications that can lead to the need for additional surgery and possibly implant removal include:

• Capsular contracture
• Leak or rupture
• Rippling or wrinkling
• Infection
• Extrusion or exposure of the implant through the skin
• Shifting or migration of an implant to an undesirable position

The FDA publication Breast Implants––Potential Local Complications and Reoperations provides a more through review.

If radiation has been or will be part of the treatment of a woman’s breast, there is an even higher rate of complications associated with the use of implants, and aesthetic results may be adversely affected.

For women contemplating reconstruction of just one breast, an additional consideration may be the degree to which a breast reconstructed with an implant will be able to match the uninvolved breast, in both appearance and feel.

Advantages to Breast Implant Reconstruction

In spite of the drawbacks and complications unique to implants, there are some advantages to implant breast reconstruction as compared to natural tissue breast reconstruction. That this method of reconstruction typically requires the shortest period of hospitalization of all methods of reconstruction may be appealing to some women. Because there is no “donor site”, there is no additional scar elsewhere on the body and no need to heal at a site other than the breast. Additionally, some women who have medical conditions that could compromise the safety of reconstructive surgery using their body’s own tissue may be able to undergo implant reconstruction safely.

The advantages of this quicker and technically less demanding reconstruction method should be weighed against the disadvantages of later complications, including capsular contracture and a high rate of unplanned re-operation and the lifespan of breast implants.

Breast Reconstruction Without Breast Implants

For women who wish to undergo restorative breast surgery without an implant, natural-tissue reconstructive procedures may be appealing.