Breast implants used in breast reconstruction are soft sacs filled with either silicone (a type of plastic) or saline (salt water) that recreate the shape of the breast when surgically inserted under chest muscle and skin. Because of the controversy surrounding the safety of silicone-gel implants, most plastic surgeons use the saline type.
Breast implantation reconstruction is a two-part procedure. The first step involves placement of a temporary balloon expander beneath the skin and chest muscle. A pocket is developed behind the muscles in the chest wall to cover the expander, and the skin is then closed. This part of the procedure takes between one and two hours. If the expander implant is done at the same time as the mastectomy, the hospital stay is generally two nights. If it is done at a later date, the expander may be implanted on an outpatient basis, or the procedure may require an overnight stay.
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The expander is somewhat flat when first implanted. Women can wear an external form in their bra if they choose.
Each week, over the course of several months, the implant is gradually expanded to the preferred size and shape with saline infusions injected through a valve in the expander. This is done in your surgeon's office.
Once a woman's skin has had sufficient time to stretch to cover a more permanent implant of the desired size, the next step is to remove the temporary expander and replace it with a permanent implant. This procedure can be done on an outpatient basis, usually under local anesthesia. Nipple reconstruction may also be performed at this time.
Implants are available in various sizes. You and your surgeon choose the size and shape that will most closely match your opposite breast. To make the match even closer, the opposite breast can be lifted or reduced.
Flap procedures -- where a woman's own tissue is used to reconstruct the breast instead of an implant -- may be an option for some women. The flap procedures result in a breast that looks and feels more natural, and one that is not vulnerable to the problems that sometimes occur with implants. The shape, feel, and contour of the breast reconstructed from a woman's own tissue far more closely resembles the natural breast. However, flap surgery is more involved than implant surgery. Complications, should they occur, can be treated in the hospital.
Flap procedures also leave additional scars on the abdomen, back, or buttocks, which usually require a longer hospital stay, lasting an average of five to six days, versus two to three days for implant procedures.
Complications of Reconstructive Surgery
While they are designed for durability, on rare occasions, a breast implant may have to be replaced due to leakage or rupture. Studies show a 5% to 10% incidence of implant ruptures after 10 years. If a saline implant ruptures, it deflates and the body absorbs the salt water.