Implant Reconstruction

Breast Reconstruction Program

The Surgery

Implant Reconstruction

Note: Before-and-after surgery photos follow the reconstruction descriptions. These photos may upset some people, however, the intent is to inform women who are in the process of making a decision about whether to undergo breast reconstruction.

*If you feel that the photos will distress you, please do not scroll down.

The simplest method of reconstruction is a breast implant under the chest muscle to create a breast mound. This can be done either at the time of the mastectomy or later. This method is suitable when the opposite breast is small and non-sagging. Because the chest muscle has to be present, this method is not appropriate for women who have had radical mastectomies.

Implants will not last a lifetime. The life span varies and they may have to be replaced or adjusted as women age and the appearance of the natural breast changes.

In Canada two types of implants are used. Saline implants (implant bags filled with salt water) and silicone gel implants. Silicone gel implants are available only with approval from Health Canada.

There are limits to the size of the breast that can be reconstructed using implants. Larger implants may require additional surgery because of problems related to symmetry and changes in the overlying soft tissue that takes place over time.

Saline implants

Saline implants have been used most frequently over the last 10 years. However, problems do exist: wrinkling, rupture and capsular contracture. If the implant ruptures, the surrounding tissues will absorb the saline within about 48 hours. The implant will need to be removed and replaced within a few weeks after rupture.

A multi-centre study reviewed the outcome of saline filled breast implants and defined the expected life span of these implants. Excluding accidental deflation, the expected life span was established to be 98.8 to 99.5% at 5 years and 97.9 to 99.5% at 10 years (Cunningham, BL, Lokeh A, & Gutowski KA).

Silicone gel implants

The silicone gel implant provides a softer and more natural breast shape and results in the implant being less visible and palpable.

Safety of silicone gel implants has been confirmed by a number of studies over the past 10 years. No evidence was found to indicate that silicone implants were associated with a significant increase in health problems (autoimmune disease such at arthritis, systemic lupus, etc).

* Being informed about breast reconstruction is important. For further information about implants go to the Health Canada Breast Implant website.

After Photos of Silicone Gel Implants

This patient had silicone gel implants after a tissue expander procedure.

Breast Reconstruction Breast Reconstruction

Before and After Photos Saline of Implant

This patient had bilateral (both breasts) mastectomies and immediate reconstruction with tissue expanders. The expanders were inflated to a size larger than the patient's pre-operative status (patient's choice).

The tissue expanders were replaced with permanent implants about 4 months later, at which time bilateral nipples were reconstructed using tissue from the reconstructed breast mound. The areolas were tattooed later.

Breast Reconstruction Breast Reconstruction

Complications after implant reconstruction

It is important to know that complication rates decrease as plastic surgeons develop more expertise in doing the surgery and that complications with breast reconstruction are similar to those associated with any type of surgery:

1. Bleeding (hematoma)

2. Problems with a general anesthesia

3. Seroma (collection of fluid under the wound)

4. Infection
Although significant wound infections are rare, when they do occur antibiotics are used to treat them. However, if infection persists, the implant may have to be removed and when this happens, further reconstructive attempts should be delayed a minimum of 3 months.

5. Capsular contracture
Fibrous tissue may form around the implant cause tightening and hardening and change the implant shape. Capsular contracture may occur within months or years after reconstruction. In some cases, it may be necessary to remove the implant and replace it with a new one.

6. Implant displacement, rupture
If these complication occur, surgery to replace the implant may be required. Mammography, ultrasound and MRI can be used to investigate a suspected rupture. However, the only certain method to establish that a rupture has occurred is surgical investigation

7. Breast asymmetry
The most common shortfall for implant reconstruction is the difficulty of matching the opposite breast in shape, size, and sensation with the implant devices currently available.

8. Delayed wound healing caused by smoking

9. Thinning of the stretched skin may cause wound healing problems

* Radiation before or after the mastectomy surgery increases the risk of complication.

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