Implant reconstruction

These are used in almost all implant reconstructions. Implants are now made with a soft, semi-solid filling called cohesive gel. This gel is quite firm and holds its shape like jelly. A softer, honey-like type of gel was previously used.

The surface of these implants can feel smooth or have a rough (textured) surface. The rougher textured implants are called macro textured; the less textured implants are called micro textured. Textured implants grip to tissue better and are less likely to move position than smooth implants. Some textured implants have been removed from sale because of a rare side effect called BIA–ALCL.

These are no longer commonly used in breast reconstruction. Saline breast implants don’t look and feel as natural as silicone implants. They may wrinkle under the skin and may leak. If the saline leaks, the implant deflates and needs to be replaced.

• The few operation takes only a hours and you usually stay in hospital for only a few days.
• Creates the breast shape without moving tissue (muscle, skin or fat) from another place in the  body, so these parts aren’t affected.
• There is only a scar in the breast area from the mastectomy and no scar elsewhere on the body.
• Recovery time at home is shorter than for a flap reconstruction. Although the chest area will be swollen and sensitive, you may be able to return to most activities after 4 weeks. Heavy lifting should be avoided for 6–8 weeks.
• Implants come in a range of shapes and sizes. You can choose to change your original breast size.
• The operation doesn’t usually cause muscle weakness, only temporary discomfort and pressure.
• Having a reconstruction may make you more confident when naked.

• May not be suitable if you plan to have radiation therapy.
• Two or more operations may be needed. If you have an expander first, the expander is gradually filled every couple of weeks. The whole process may take 3–6 months.
• A breast reconstructed with a tissue expander usually feels firm and doesn’t move like the original breast, but it usually looks the same in a bra.
• If your other breast changes in shape and size, you may need more surgery to match the 2 breasts.
• Hardened scar tissue (capsule) may form around the implant. This can change the shape of the breast and may be painful.
• There is a risk of infection, which may mean removing the implant.
• Implants may eventually need to be replaced.
• There are some rare side effects.
• There may be an increased risk of lymphoedema (swelling in the soft tissue under the skin).

You’ll be given antibiotics at the time of the operation to reduce the risk of infection. If you do get an infection, the implant may have to be removed until the infection clears. The implant can then be replaced with a new one.

Implants can leak or break (rupture) because the silicone gradually weakens over time. If a saline implant ruptures, salty water will leak into your body. The salty water is not harmful, but you will need to have surgery to remove the empty silicone envelope and replace the implant.

Implants may need to be changed every 10–15 years, or earlier if there are any problems. Regularly examine your breasts, armpit and implant for any changes. See your surgeon or GP every year forcheck-ups, which will include scans.

A fibrous covering can form around a breast implant. If this hardens over time, it may make the reconstructed breast feel firm. This is called capsular contracture, and it is more common after radiation therapy. Capsular contracture can be uncomfortable or painful and may change the shape of the breast. You may need to have additional surgery to remove or replace the implant. A new surgical procedure called capsulotomy can be done to loosen the scar tissue surrounding the implant.

The position of the implant in the body may change slightly over time. This is called implant malposition, displacement, descent or rotation. In a small number of cases, the implant shifts a lot and changes the shape of the breast. Further surgery can restore the implant to its original position.

Sometimes implants adhere to the surface of the skin and this can affect how smooth the breast is. This can often be corrected with minor surgery, which injects fat from another part of the body under the skin. This is called lipomodelling.

There have been reports of a link between a type of non-Hodgkin lymphoma and textured breast implants. This is known as breast implant associated anaplastic large cell lymphoma, or BIA–ALCL, and it is rare. BIA–ALCL is a cancer that grows in the fluid and scar tissue that forms around a breast implant. Implants that have a smooth surface have not been linked to BIA–ALCL. The Therapeutic Goods Administration (TGA) recommends monitoring your breasts for any changes such as swelling, a lump or pain.

For more information about BIA–ALCL, visit the Therapeutic Goods Administration (TGA) and search “BIA–ALCL for consumers”. The TGA also has an online breast implant hub, where information and support related to breast implants and their safety are updated as new evidence becomes available (visit tga.gov.au/hubs/breast-implants). If you are concerned, talk to your surgeon.

Research has not established that silicone breast implants cause autoimmune disorders such as scleroderma, rheumatoid arthritis or lupus. There is also no evidence that implants cause breast cancer.