Breast reconstruction is a surgical procedure that restores shape to your breast after mastectomy — surgery that removes your breast to treat or prevent breast cancer.
One type of breast reconstruction uses breast implants — silicone devices filled with silicone gel or salt water (saline) — to reshape your breasts. Breast reconstruction with breast implants is a complex procedure performed by a plastic surgeon.
The breast reconstruction process can start at the time of your mastectomy (immediate reconstruction), or it can be done later (delayed reconstruction). The breast reconstruction process usually requires two or more operations — and several visits to your surgeon — to insert, position and fill the breast implants.
Breast reconstruction won't re-create the exact look and feel of your natural breast. However, the contour of your new breast may restore a silhouette similar to what you had before mastectomy.
Breast reconstruction with a breast implant carries the possibility of complications, including:
- Breasts that don't match each other in size or appearance (asymmetry)
- Breast pain
- Implant rupture or deflation
- Poor healing of incisions
- Increased risk of future breast surgery to replace or remove the breast implant
- Changes in breast sensation
- Scar tissue that forms and compresses the implant and breast tissue into a hard, unnatural shape (capsular contracture)
- Risks associated with anesthesia
- Very low, but increased risk of a rare immune system cancer called anaplastic large cell lymphoma (ALCL), though more research is needed to understand the relationship between ALCL and breast implants
Correcting any of these complications may require additional surgery.
If you need adjuvant radiation therapy to the skin and chest wall after a mastectomy (post-mastectomy radiation), you might not be an ideal candidate for breast implant reconstruction. Having a breast implant may make it more difficult to deliver the radiation therapy effectively, and the implant may need to be deflated. There may also be a higher risk of complications. The skin and underlying tissue may become firmer, discolored and swollen due to radiation therapy.
How you prepare
Before a mastectomy, your doctor may recommend that you meet with a plastic surgeon. Consult a plastic surgeon who's board certified and experienced in breast reconstruction following mastectomy. Ideally, your breast surgeon and the plastic surgeon should work together to develop the best surgical treatment and breast reconstruction strategy in your situation.
Your plastic surgeon will describe your surgical options and discuss the advantages and disadvantages of implant-based reconstruction, and may show you photos of women who have had different types of breast reconstruction. Your body type, health status and cancer treatment factor into which type of reconstruction will provide the best result. The plastic surgeon provides information on the discoloured, the location of the operation and what kind of follow-up procedures may be necessary.
Your plastic surgeon may discuss the pros and cons of surgery on your opposite breast, even if it's healthy so that it more closely matches the shape and size of your reconstructed breast. Surgery to remove your healthy breast (contralateral prophylactic mastectomy) can double the risk of surgical complications, such as bleeding and infection. Also, there may be less satisfaction with cosmetic outcomes after surgery.
Before your surgery, follow your doctor's specific instructions on preparing for the procedure. This may include guidelines on eating and drinking, adjusting current medications, and quitting smoking.