The most common method of breast reconstruction combines a two-step procedure where first, the chest skin and soft-tissue is expanded using a medical device called a tissue expander, followed by exchange of the temporary tissue expander for a saline or silicone-filled permanent breast implant.
An implant cannot be placed immediately after a mastectomy as there is insufficient soft-tissue cover over the breast implant. The skin envelope would be too tight and the tight skin envelope would distort the shape and appearance of the reconstructed breast. To achieve a natural appearing breast reconstruction with breast implants, a tissue expander has to be placed first to prepare the chest for the final breast implant.
The initial operation involves insertion of the tissue expander, which is a medical device placed at the mastectomy site that helps expand the chest skin and soft tissues and develop the space required for the future breast implant. This is done as outpatient surgery, meaning you go home the same day. No drains are required and we use the same scar as from the mastectomy; no new scars are created. The surgery is relatively quick (1 – 2 hours) and time off from work is usually about 1 week.
The tissue expander is placed behind the pectoralis major muscle to provide more of your own tissues over the (salt) water-filled device. Often 1-3 visits to the clinic are required after your surgery, in which the expander is expanded with saline injections to create a future pocket for the final saline or silicone breast implant.
Two weeks later, the expansion is continued in the clinic. Through a port within the tissue expander beneath your skin, the tissue expander is gradually filled with sterile saline to shape and form the skin envelope pocket necessary for the breast implant. This expansion process in the clinic is not painful and is very well tolerated by patients. After the chest tissues for the breast implant have been prepared, the tissue expander is removed in a second outpatient surgery and the permanent soft saline or silicone breast implant inserted. The second operation is done 4-5 months after insertion of the tissue expander.
The goal of breast implant reconstruction is to restore form and symmetry without the need for an external breast prosthesis. However, patients who have had radiation for breast cancer treatment are unlikely to be candidates for implant-based reconstruction. Patients who have had radiation require one of the tissue-based methods of breast reconstruction. If you have questions, read our commonly asked questions or call to schedule a consultation.
Although complications are infrequent, there is a remote possibility that an infection can occur. Implants can leak, which requires surgery to remove the defective implant and replace it with a new one. The more common problem, capsular contracture, occurs if your tissue capsule around the implant begins to tighten and feel hard. In more severe cases, this may require an operation to remove the scar tissue and replace the implant. However, the risk of any of these complications developing is low.
We encourage you to meet with Dr. Frank Isik, see additional patient photos and determine whether this method of breast reconstruction is your best choice. Also, we have many patients that have had a Saline or Silicone Implant for breast reconstruction that would be happy to share their experience and answer your personal questions. We have a breast cancer and reconstruction support group that meets once a month. This is an opportunity to meet and often see other patients that have had a TRAM, Latissimus, or Implant method of breast reconstruction. Please contact us to find out more.
We perform surgery for patients from Seattle, Bellevue, Kirkland and the greater Western Washington area. For patients from Eastern Washington, Idaho, Montana and Alaska, we coordinate reduced rate accommodations at several high-quality hotels that are within walking distance of our plastic surgery center and downtown Seattle.
Breast Implant Information
Breast implants are commonly used by plastic surgeons in cosmetic breast surgery and breast reconstruction surgery. Breast implants come in one of two types: saline filled or silicone filled. All patients can opt to have saline-filled breast implants for aesthetic breast augmentation or breast reconstruction purposes. Because of FDA regulations, patients that desire silicone-filled breast implants for breast augmentation need to be 22 years old or older. There are no age restrictions on the use of silicone breast implants for breast reconstruction.
Breast implants were first introduced in 1961 by Dow-Corning as silicone-filled breast implants and subsequently, saline-filled breast implants were introduced in 1964. Although many variations in the filler material have occurred over the decades, both the saline filled and silicone filled breast implants remain in use today. Both breast implants are similar in that the outer membrane is made from solid silicone. As far as we know, there is no health risk from the outer solid silicone membrane. All of the health concerns regarding silicone have been related to the silicone gel inside the implants.
The old silicone gel-filled breast implants (pre-1992) had a silicone gel filler that was encased within a thin outer membrane of solid silicone. This older generation breast implants had a higher tendency to rupture and the free silicone would then contact the patient’s own tissues. In rare cases, the free silicone gel would migrate to the lymph nodes.
Numerous scientific studies have been done since 1992 to determine whether the older silicone breast implants caused health problems. Studies from the National Cancer Institute, National Institutes of Medicine, FDA and the Harvard Nurses Health Study have not shown a clear link between saline or silicone filled breast implants and auto-immune diseases. Studies have also shown no increased risk of developing breast cancer or problems in detecting breast cancer if you had breast augmentation in the past with either saline or silicone filled breast implants.
Whereas the safety profile of silicone breast implants are being resolved with numerous long-term ongoing clinical trials, the data suggests that they are safe. In fact, the rupture rates on the latest approved silicone breast implants are less than 3%, superior to the saline breast implants (close to 5%). However, since silicone implant ruptures are often unnoticed by the physician or patient, you will require an MRI every 3 years.
Saline filled breast implants are known to be safe . Saline breast implants are filled with salt-water that if it should leak, would not result in any bodily harm. You will have to have an outpatient surgery to replace the defective implant. Saline breast implants have been in use for decades and the safety profile has been well established.
To learn more about the different breast reconstruction methods available, download our breast reconstruction brochure.