Breast Reconstruction: Your Choice

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Implants

Before surgeons perfected the process of transplanting tissue to recreate breasts, implants were the only available method. Used by women for more than 40 years, implants now account for about half of all breast reconstructions.

Implants come in different shapes (round or contoured), textures, and sizes, so your surgeon must choose the model that will best fit your chest and give you the volume you want.

Compared to natural tissue flap procedures, implant surgery is shorter, requires less surgical skill, and leaves fewer scars. Recovery is faster, but the entire reconstructive process can take longer to complete. If you combine nipple-sparing mastectomy with implant surgery, however, you may be able to complete your entire reconstruction in a single trip to the operating room. While most women are happy with their implants, there are downsides. With unilateral reconstruction, it can be difficult to match your natural breast without additional surgery, because implants can't be shaped or sculpted like living tissue. Your implanted breast won't droop or reflect weight changes like your opposite breast, so you may become asymmetrical over time. Unlike living tissue, implants are devices: they are susceptible to complications, and sooner or later they must be replaced.

For many women, implants are a good reconstructive choice, and they may be right for you too. Before you decide, understand their benefits and limitations. Ask your plastic surgeon to show you samples of both saline and silicone implants, so you can touch them and compare how they feel. Talk to other women who have had reconstruction with implants.  Compare them to tissue flap reconstruction and then decide which is the best choice for you.

siliconegel.implant.gif
Silicone gel implant
inamed.saline.jpg
Saline round implant

Silicone gel implants
have a resilience and bounce much like natural breast tissue. Widespread use was approved by the FDA in 2006, 14 years after the agency imposed a moritorium on the devices over questions of safety. Silicone impants are now approved for breast reconstruction in women of all ages and breast augmentation in women ages 22 and older.

While virtually all studies failed to link silicone implants to serious diseases, concerns remain over how often the implants rupture and what happens when and if silicone migrates beyond the breast. The FDA suggests women with silicone implants have periodic MRIs to determine whether a "silent" rupture has occurred; unlike saline implants, rupture of a silicone implant may not be apparent.

What's new in implants

Patient-controlled expansion without fills?

Designed by a plastic surgeon, the Ideal is a silicone shell with several nested compartments of saline, rather than a single bag of fluid like standard saline implants. The new design is said to provide a natural feel to the breast with less wrinkling, rippling or bulging on the sides. A two-year FDA trial of the Ideal Implant began in 2010.

The design for this implant features honeycomb pockets filled iwth nothing but air. Designed by an Israeli plastic, the Implite is saiid to be one-third the weight of standard implants with no risk of leakage or deflation if it ruptures. Targeted to women who want partial reconstruction after lumpectomy. No FDA trials are scheduled.

This new system for breast augmentation uses hundreds of miniature silicone "raisins" instead of one large silicone implant. Patients can later increase or decrease breast size in an office procedure with just local anesthesia. Clinical trials may begin in 2010.

Updated November 2011

Note: The information on this site is provided for educational purposes only and should not be interpreted as medical advice.
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