Implant Breast Reconstruction is a two-staged breast reconstruction technique recreates the breast shape by the placement of a breast implant underneath the chest skin.
 
Patients who qualify for this type of reconstruction are those who have not had radiation or will not have radiation after surgery.  In patients who are very skinny and do not have enough fat on their body to reconstruct a breast, or those who had previous tummy tuck, implant reconstruction may be the only option.  Finally, patients who are not willing to undergo an extensive microsurgical reconstruction have the option of requesting an implant reconstruction.
 
This is a two-staged procedure.  In the initial phase, a tissue expander is placed under the pectoralis muscle and skin.  It is a silicone balloon which then requires that the patient keeps coming back to the clinic for weekly expansions (water is injected into the balloon to expand it).  This process takes a few weeks.  The goal is to inflate the balloon to the desired volume, and then to expand it an additional 20% to ‘over-expand’ it.  This creates a pocket under the skin that is larger than the implant which will be placed in the second phase of the surgery.  Over-expansion then allows the implant to droop a little, mimicking the natural droop of a breast.
 
The second phase then takes place approximately 3-4 months after the first phase.  In this phase the expansion balloon is replaced by the permanent implant through a very minor procedure which will allow you to go home the same day.
 
Implant reconstruction has the advantage over microsurgical flap reconstruction in that it is a much simpler and quicker surgery.  There is minimal risk of initial failure.
 
Unfortunately, overall, implant reconstruction is less desirable because implants never feel as natural as flap-reconstructed breast, and they rarely look as natural.  Unlike breast augmentation where the implant lies under a thick layer of skin and fat (and sometimes muscle), in breasts that underwent a mastectomy only a very thin layer of skin is left behind.  This very thin skin is not able to hide the implant and its imperfections.  Thus it will be very obvious that you have implants under your skin.   Infection of the implant is rare but significant problem that can occur and most often requires the removal of the implant for a minimum of 3 months until the infection settles.  Capsular contracture is another complication that is frequent (30% of patients develop this within three years), especially if you had radiation to your breast(s).  Capsular contracture deforms the shape of the implant, and causes pain.  It require release of the contracted tissue.  Even though it is a minor procedure, it can recur endless number of times and thus frequent visits to the hospital for contracture release can become annoying.  Finally, implants have a finite lifespan, and will require replacement in 10-15 years.
 
Implants do NOT affect your overall health, not even if the implant is filled with silicone.  Nor do they increase your risk of future cancer or interfere with the detection of cancer.
 
 
Below is a table with various implant complications occurring within 3 years of the surgery
 
Implant Breast Reconstruction
View immediately after the skin is closed following exchange of tissue expanders for final implants
Cross-section of the chest immediately after mastectomy.  Skin covers the underlying pectoralis muscle.  On the right you see the breast implant sitting under the skin and muscle, on top of the ribs.
Patient after placement of tissue expanders, before full expansion is complete
Side view of tissue expander during the expansion phase
Six months after nipple-areola reconstruction, one year after implant placement
Relevant Links
  1. •ASPS
  2. •Breastcancer.org
Before agreeing to undergo any surgical or non-surgical procedure, be sure to review potential complications which you may face.
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