What is a breast reconstruction with an implant or tissue expander?

A breast reconstruction is an operation to recreate a breast shape after you have had a mastectomy (removing all of your breast). Your surgeon will use a breast implant or tissue expander (expandable implant) to recreate the shape of a breast.

The Therapeutic Goods Administration (TGA) continues to review and assess breast implants available in the Australian market.

In September 2019, the TGA decided to recall and suspend a number of breast implants and tissue expanders due to a small risk of breast implant-associated anaplastic large cell lymphoma. The TGA provides a list of the affected products and consumer information on the recall and associated risks.

What kind of breast implant should I choose?

All implants are made of an outer layer (shell) of silicone or polyurethane. They can be filled with silicone or saline (salt water).

Softer silicone and saline implants give a softer and more natural feel but are more prone to kinking or rippling.

More cohesive silicone implants give a firmer feel, hold their shape more and are less prone to kinking or rippling.

If you have already had a mastectomy or your surgeon thinks your breast skin is unsuitable for a prosthesis straight away, they may need to use a tissue expander. Over a number of weeks your surgeon will gradually fill the tissue expander with saline through a small tube (port) to stretch your skin and make your breasts similar in size. This is changed over in a simple procedure once your skin is stretched enough. This may be delayed if you need radiotherapy to your chest wall.

Is silicone safe?

There is no evidence to suggest that people with silicone breast implants have a higher risk of developing diseases such as breast cancer and arthritis.

There is a reported link between having an implant and a rare type of cancer called anaplastic large-cell lymphoma (ALCL) but the increase in risk is small and ALCL in this area is not as serious as it is when it happens elsewhere in your body.

What are the benefits?

You should get a breast shape again. Most people who have a successful breast reconstruction are more comfortable with their appearance.

Are there any alternatives?

Using padded bras or bra inserts can give the appearance of a breast shape when you are wearing clothes.

It is possible to use tissue from another area of your body, usually your lower abdomen or sometimes from your buttocks, inner thigh or side.

A reconstruction can be performed using the latissimus dorsi muscle that is moved from the side of your back and used to recreate a breast shape.

What will happen if I decide not to have the operation or the operation is delayed?

A breast reconstruction will not improve your physical health. Your surgeon may be able to recommend an alternative to recreate a breast shape. Your healthcare team may be able to provide prosthetic and underwear fitting which may help with your body image.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

If you have already had a mastectomy there is usually not enough skin to recreate a breast shape so you will need a tissue expander to stretch your skin. Your surgeon will make a cut on the front of your chest over the mastectomy scar, or at the lower end of your new breast. They will create a pocket under the muscle to place the tissue expander in.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. If you gain weight after your cancer surgery, this operation may not be considered safe.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the breast team or your GP for advice.

You can reduce your risk of infection in a surgical wound by taking the following steps:

• In the week before the operation, do not shave or wax the area where a cut is likely to be made.
• Try to have a bath or shower either the day before or on the day of the operation.
• Keep warm around the time of the operation. Let the breast team know if you feel cold.
• If you are diabetic, keep your blood sugar levels under control around the time of your procedure.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

• bleeding
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• venous thromboembolism (VTE)
• chest infection

Specific complications of this operation

Breast reconstruction complications

• developing a lump under your wound caused by fluid collecting
• developing a lump under your wound caused by blood collecting
• wound breakdown, where a wound fails to heal and opens up
• skin necrosis, where some of the original breast skin at the edge of your wound dies leaving a black area
• difference in shape and appearance
• breast implant illness. Some women report a range of symptoms following breast implant surgery. When there is no medical diagnosis this is called breast implant illness
• numbness or continued pain around your armpit or the inner part of your arm
• permanent numbness around the scar on your chest

Implant complications

• developing a collection of fluid (seroma) in the pocket where the implant is
• capsule contracture, where scar tissue that your body naturally forms thickens and tightens around the implant
• rupture of an implant
• kinking and rippling
• infection of the implant
• removal of the implant in the future
• rare cancer (anaplastic large-cell lymphoma - ALCL)

Consequences of this procedure

• pain
• unsightly scarring of your skin
• The prosthesis may feel cold in the winter

How soon will I recover?

You should be able to go home the same day.

You should be able to return to normal activities after 4 to 6 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Do not do rigorous sports, such as tennis, horse riding, golf or aerobics, for 2 months without asking your breast team for advice.

Before you start exercising, ask the breast team or your GP for advice.

If your surgeon needed to use a tissue expander, you will need to come back to the clinic regularly.

The shape of your reconstructed breast takes several weeks to settle.

Summary

A breast reconstruction with a breast implant or tissue expander is an operation to recreate a breast shape. You should consider the options carefully and have realistic expectations about the results.

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