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Understanding BRCA & HBOC > Breast Reconstruction > Types of Reconstruction

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Types of Reconstruction

This section outlines the many options available and information about reconstructing breasts following mastectomy.

Implant reconstruction

Implant reconstruction uses saline or silicone breast implants to create breast shape and volume.

Both types are available in different volumes and shapes, so your surgeon can choose one that best fits your anatomy and desired size. Saline implants have a silicone shell filled with salt water. Breasts reconstructed with saline implants tend to feel firmer than silicone, which is softer and has a texture more like natural breast tissue. Silicone implants are filled with liquid or cohesive gel silicone. Their use is still controversial; while some fear implants may leak and spread silicone into the breast tissue or beyond, others consider the natural feel and weight of silicone implants is worth the risk. No matter which type implant is used, it is always placed under the pectoralis chest muscle (unlike breast augmentation, which usually places the implant between the breast tissue and muscle).

Generally, implant reconstruction involves two phases: first, temporary implants called expanders are placed in pockets formed under the chest muscles. Over several weeks the expanders are gradually inflated with saline to stretch the skin and muscles. During a second shorter surgery, the expanders are replaced with implants that best fit your anatomy and desired size.

Two single-step procedures may be options for small-breasted women. An adjustable hybrid  expander-implant can be placed and gradually inflated. When fully expanded, it is sealed and remains in place, eliminating the need for exchange surgery. Another newer technique completely eliminates the need for expansion. Non-expansive breast reconstruction uses Alloderm, a synthesized skin product, to cover portions of the implant.

Implants aren’t permanent. Sooner or later they wear out and must be removed and/or replaced. Sometimes this occurs sooner if the implant leaks or is distorted by hard scar tissue that forms around it. Some women need their implants replaced within a year of reconstruction; others may have their implants for 15 years or longer. It is obvious when a saline implant deflates, because the breast collapses (think of a balloon losing air). Deflation of silicone implants is often undetected, because the implant retains its shape. For this reason, some experts recommend women have a yearly MRI to determine if their silicone implants are intact. 

Implants are a good option for women who:

  • don’t mind potentially having less projection
  • haven’t previously had chest or breast irradiation
  • don’t mind having to replace the implants at sometime in the future
  • don’t want to endure a longer recovery from tissue flap surgery or scar another area of the body