Implants for Breast Reconstruction

This page was reviewed under our medical and editorial policy by Antoine Carre, M.D., M.P.H., assistant clinical professor, Division of Plastic Surgery, Department of Surgery, and assistant clinical professor; and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

After a mastectomy that removes all or a portion of the breast, patients may consider two options for breast reconstruction: breast implants or flap surgery.

While some breast cancer patients may choose to forego breast reconstruction surgery altogether, if a patient chooses breast reconstruction to restore the look of their breasts, implants are one way to achieve that goal.

For patients selecting reconstruction with breast implants, several types are available, including saline, silicone, textured and smooth ones. In some instances, the doctor may recommend combining implants and flap surgery to reconstruct the breast.

This guide is designed to help patients understand today’s breast implant options, as well as their pros and cons, and possible complications.

What Are Breast Implants?

Breast implants are medical devices that a surgeon implants under the breast skin or muscle to replace tissue removed due to cancer or a traumatic injury. They have an outer shell of silicone (synthetic gel) and come in a variety of:

• Sizes
• Shapes (round or teardrop)
• Fillings (saline or silicone)
• Shell thicknesses

Implants made for breast reconstruction also have varying profiles, that is, how much they project from the chest when a person is standing. The profile takes into account both the size and width of the implants. There are three types, as listed below.

Low-profile implants: These project minimally from the chest and are usually well-suited for women with wider chests.

Moderate-profile implants: These provide medium levels of projection, tend to look the most natural and are typically ideal for women with narrow or small chests.

High-profile implants: These provide the greatest projection for a rounder, fuller look and are typically ideal for petite, narrow-chested women.

Types of Breast Implants

Saline Breast Implants

While the outer shell of all breast implants is made of silicone, saline implants are filled inside with sterile salt water (saline). They are approved for breast enhancement by the U.S. Food and Drug Administration (FDA) in adults aged 18 and older and for breast reconstruction in women of any age. However, saline implants may not lead to optimal aesthetics for the patient, so they aren’t often recommended for breast reconstruction.

Some saline breast implants are filled before surgery, and others are filled during the procedure itself. Structured saline breast implants have some supportive chambers inside to make them feel more natural and hold their shape.

Mastectomy patients seeking consistent firmness and shape may prefer saline breast implants. They should be aware, however, that saline implants may feel less natural than silicone, and reported patient satisfaction is lower. In addition, since they are filled with water, sometimes ripple effects may be noticeable, especially for those with thinner skin.

However, this rippling typically makes it easier to detect if an implant has ruptured and is leaking. For this reason, there is no guideline recommendation for periodic magnetic resonance imaging (MRI) scans to check for ruptures with saline implants as there is for silicone implants.

Silicone Breast Implants

Breast implants also include a silicone-filled option, which is approved by the FDA for breast enhancement in adults aged 22 and older, or for anyone undergoing breast reconstruction surgery. The silicone filling is a medical-grade synthetic gel.

Most breast implants used for breast reconstruction surgery in the United States are silicone-filled. They tend to feel more natural than saline implants and provide greater satisfaction for the patient. But because leaks may be difficult for patients with silicone implants to detect, experts recommend having an MRI scan every few years to check for ruptures. The doctor will provide a suggested follow-up schedule to monitor for silicone implant leaks.

“Gummy bear” breast implants are a popular type of silicone implant that patients may choose. These implants are considered more stable than regular silicone implants because they are filled with a thicker synthetic gel. They tend to hold their shape even when the outer shell is punctured. They project away from the body more at the bottom and taper at the top. The downside is that these may appear quite abnormal if they rotate, and a surgery may be needed to correct the rotation.

Smooth Implants

Smooth shells on the outside of an implant have a soft feel and tend to move naturally in the pocket created for them during breast reconstruction surgery. However, like saline-filled implants, this may produce a rippling effect that is clearly visible beneath the skin.

Implant Placement

Breast implant procedures include two placement options:

• Subpectoral, meaning placement under the muscle
• Prepectoral, meaning placement over the muscle (just under the skin), which is the preferred location

Under-the-Muscle or Subpectoral

During an under-the-muscle breast implant procedure, the surgeon lifts the pectoralis major muscle, which sits under the breast tissue, to help form a pocket. Often, a biodegradable mesh known as acellular dermal matrix (ADM) is then positioned in this pocket, allowing for placement of the implant inside. The ADM is used to help create a rounded breast shape.

For subpectoral implants, drains may be placed during the procedure and removed a few days to weeks later.

Patients undergoing the procedure may experience less wrinkling of the breast than those who have a prepectoral implant because the muscle helps prevent this. However, the healing time may be longer, and a follow-up visit may be necessary to remove the drains. In addition, there may be more pain with a subpectoral implant, as well as loss of strength in the arm and a less appealing appearance.

Over-the-Muscle or Prepectoral

During a prepectoral procedure, the breast implant is wrapped in ADM or stitched to help keep it in the right place. It is then inserted above the pectoralis major muscle.

One advantage of this procedure is that patients tend to heal faster because the pectoral major muscle is not moved. Compared to subpectoral implants, over-the-muscle implants tend to move less when the muscle contracts.

A potential disadvantage of prepectoral breast implants is that, over time, more wrinkling and rippling may occur in the upper breast than with subpectoral implants. For this reason, the doctor may recommend transferring fat to the breast from other parts of the body to supplement the implant. This is sometimes referred to as a fat transfer breast implant or augmentation.

Breast Implant Complications

There are a number of potential complications of breast implants, including:

• Breast pain
• Nipple sensation changes
• Uneven breasts or chest wall deformity
• Visible rippling or wrinkling
• Displacement of the implant, which may happen during surgery or after the procedure
• Thinning or shrinking of the breast skin
• Inflammation
• Skin redness, bruising or rash
• Blood clots
• Fluid collection in the breast that causes a lump
• Breast implant rupture, which is a hole in its shell that may cause the implant to deflate
• Capsular contraction, which is scar tissue forming around the implant
• Possible inability to breastfeed
• Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL)
• Additional surgeries to replace, remove or reposition the implant; address scar tissue issues; remove cysts; or drain fluids after the procedure
• Breast implant illness (BII), which includes various debilitating symptoms throughout the body

While mammograms to check for cancer or other structural issues are not usually performed on a breast with an implant after mastectomy, the other unaffected breast may still safely be screened and checked for possible cancer recurrence. Recommendations may vary from patient to patient. Patients should discuss with their doctor whether regular mammograms of a breast with an implant after mastectomy are needed. Implants may get in the way of viewing breast tissue on a mammogram, and patients should work with a radiologist who is experienced in taking images of breasts with implants.

Women who had reconstruction with flap tissue may still undergo mammograms of affected and unaffected breasts, also based on a discussion with their doctor.

Breast Implant Illness

Several symptoms make up breast implant illness (BII), including fatigue, trouble concentrating, joint pain, memory loss, anxiety, depression, muscle pain and skin rash. Some women report these and other systemic symptoms after having breast reconstruction surgery or breast implants.

These may be signs that the body is rejecting the implants, since removing them sometimes stops BII. It is important to contact the doctor right away if BII or other symptoms occur after breast implant surgery so that necessary treatments may be considered.

How Long Do Breast Implants Last?

The length of time that breast implants last varies, although they are created to last more than a decade. Some doctors may recommend changing implants every 10 years to reduce the risk of rupture and leakage from regular wear and tear.